The effect of fresh frozen plasma in severe closed head injury

Etemadrezaie, Hamid; Baharvahdat, Humain; Shariati, Zhaleh; Lari, Shahrzad M.; Shakeri, Mohammad Taghi; Ganjeifar, Babak

doi:10.1016/j.clineuro.2006.09.001

Cited by 75 publications

(61 citation statements)

References 22 publications

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“…35 However, it is less clear whether albumin should/can be used when TBI co-exists with an extracranial diagnosis (such as sepsis) where albumin may be indicated. A further two completed adult RCTs of fluid management were identified, of which one 63 reported lower mortality in patients receiving fresh frozen plasma, compared with placebo.…”

Section: Fluid Management (Three Rcts)mentioning

confidence: 99%

A State-of-the-Science Overview of Randomized Controlled Trials Evaluating Acute Management of Moderate-to-Severe Traumatic Brain Injury

Bragge

Synnot²,

Maas

et al. 2016

Journal of Neurotrauma

103

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Moderate-to-severe traumatic brain injury (TBI) remains a major global challenge, with rising incidence, unchanging mortality and lifelong impairments. State-of-the-science reviews are important for research planning and clinical decision support. This review aimed to identify randomized controlled trials (RCTs) evaluating interventions for acute management of moderate/severe TBI, synthesize key RCT characteristics and findings, and determine their implications on clinical practice and future research. RCTs were identified through comprehensive database and other searches. Key characteristics, outcomes, risk of bias, and analysis approach were extracted. Data were narratively synthesized, with a focus on robust (multi-center, low risk of bias, n > 100) RCTs, and three-dimensional graphical figures also were used to explore relationships between RCT characteristics and findings. A total of 207 RCTs were identified. The 191 completed RCTs enrolled 35,340 participants (median, 66). Most (72%) were single center and enrolled less than 100 participants (69%). There were 26 robust RCTs across 18 different interventions. For 74% of 392 comparisons across all included RCTs, there was no significant difference between groups. Positive findings were broadly distributed with respect to RCT characteristics. Less than one-third of RCTs demonstrated low risk of bias for random sequence generation or allocation concealment, less than one-quarter used covariate adjustment, and only 7% employed an ordinal analysis approach. Considerable investment of resources in producing 191 completed RCTs for acute TBI management has resulted in very little translatable evidence. This may result from broad distribution of research effort, small samples, preponderance of single-center RCTs, and methodological shortcomings. More sophisticated RCT design, large multi-center RCTs in priority areas, increased focus on pre-clinical research, and alternatives to RCTs, such as comparative effectiveness research and precision medicine, are needed to fully realize the potential of acute TBI research to benefit patients.

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Section: Fluid Management (Three Rcts)mentioning

confidence: 99%

A State-of-the-Science Overview of Randomized Controlled Trials Evaluating Acute Management of Moderate-to-Severe Traumatic Brain Injury

Bragge

Synnot²,

Maas

et al. 2016

Journal of Neurotrauma

103

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“…In addition, not only can large volumes of plasma precipitate pulmonary edema in patients with cardiac dysfunction, a number of studies have also documented worse outcomes in patients who required large volume transfusions of plasma during acute care hospitalizations. [13][14][15][16] Recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) is a drug developed for treatment of hemophiliacs with inhibitors to factors VIII and IX. 9,17 Recombinant factor VIIa has become increasingly used "off-label" in patients for both traumatic and nontraumatic neurosurgical emergencies.…”

mentioning

confidence: 99%

Reversal of Coagulopathy in Critically Ill Patients With Traumatic Brain Injury: Recombinant Factor VIIa is More Cost-Effective Than Plasma

Stein

Dutton

Kramer

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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In this study, we were able to demonstrate a significant economic benefit of the use of rFVIIa for reversal of coagulopathy in severely injured patients with TBI. Not all patients with coagulopathy and an anatomic brain injury benefit, but in patients who are neurologically or physiologically compromised, using rFVIIa decreases total charges and costs of hospitalization. This decrease in overall cost is directly attributable to the significant decrease in LOS and decrease in the need for mechanical ventilation. This study demonstrates that in coagulopathic patients with TBI who require intensive care unit admission, rFVIIa is cost-effective and safe. Prospective studies are needed to confirm these findings and establish clinical effectiveness.

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“…28 That may be associated with the development of many secondary complications. 29 We found that in DC group platelet count was associated with long-term prognosis rather than other coagulation indicators, which indicated that platelets count may be a more sensitive prognostic predictor for severe TBI patients undergoing DC. Meanwhile, there was no connection between coagulopathy and prognosis of TBI patients undergoing standard care, which may mean that the factors of coagulopathy had a tighter relation with DC.…”

Section: Role Decompressive Craniectomy Plays In the Treatment Of Sevmentioning

confidence: 92%

Analysis of Long-Term Prognosis and Prognostic Predictors in Severe Brain Injury Patients Undergoing Decompressive Craniectomy and Standard Care

Tian

Wen

et al. 2015

Journal of Craniofacial Surgery

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Decompressive craniectomy (DC) is widely used to treat acute subdural haematoma and hemispheric swelling following traumatic brain injury (TBI). The therapeutic effect of DC on severe TBI treatment is still controversial. The aim of our study was to evaluate effectiveness of DC treatment and seek some prognostic predictors. According to the therapy method, we divided the patients into 2 groups: DC group and standard care group. Between 2010 and 2014, a total number of 223 severe TBI patients, containing 112 patients undergoing DC and 111 patients undergoing standard care, were enrolled into the study according to Glasgow Coma Scale (GCS). The long-term prognosis was evaluated by Extended Glasgow Outcome Scale 12 months after discharging from hospital. We used univariate analysis and receiver operating characteristic curves to explore prognostic predictors. The results showed that patients in the DC group had a lower mortality, but there was no statistical significance in long-term prognosis between these 2 groups. It seemed that admission GCS, platelet, neutrophile granulocyte, total protein, and albumin were associated with long-term prognosis in DC group and reactivity of pupils in standard care group. Simultaneously, using the multivariable logistic regression model, we confirmed that admission GCS and albumin were independent prognostic predictors for patients undergoing DC, and reactivity of pupils for those undergoing standard care. Our data suggested that DC was an effective therapy for severe TBI patients in reducing mortality, but it failed to improve long-term prognosis. Through our study, we could comprehend the characteristics of the 2 treatments and provide more scientific individuation therapy for severe TBI patients.

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The effect of fresh frozen plasma in severe closed head injury

Cited by 75 publications

References 22 publications

A State-of-the-Science Overview of Randomized Controlled Trials Evaluating Acute Management of Moderate-to-Severe Traumatic Brain Injury

A State-of-the-Science Overview of Randomized Controlled Trials Evaluating Acute Management of Moderate-to-Severe Traumatic Brain Injury

Reversal of Coagulopathy in Critically Ill Patients With Traumatic Brain Injury: Recombinant Factor VIIa is More Cost-Effective Than Plasma

Analysis of Long-Term Prognosis and Prognostic Predictors in Severe Brain Injury Patients Undergoing Decompressive Craniectomy and Standard Care

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