The impact of fresh frozen plasma vs coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion

Nienaber, Ulrike; Innerhofer, Petra; Westermann, Isabella; Schöchl, Herbert; Attal, R.; Breitkopf, Robert; Maegele, Marc

doi:10.1016/j.injury.2010.12.015

Cited by 146 publications

(92 citation statements)

References 40 publications

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“…Fenger-Eriksen and colleagues (2009) [18] was a double-blinded randomized trial conducted at a single institution that compared the efficacy of FIBC in reducing perioperative ABT requirement and reversing acquired coagulopathy-as measured by maximum clot firmness (MCF)-induced by hydroxyethyl starch (HES) compared to isotonic sodium chloride solution in elective radical cystectomy for localized bladder cancer. Of the 3 retrospective studies, 2 used data from trauma registries [19,20], whereas the third was a single-center study [21].…”

Section: Non-cardiac Surgerymentioning

confidence: 99%

“…Two of the retrospective studies in this group [19,20] compared TEM-guided dosing of FIBC and 4-factor PCC against trauma registry data constituting prevailing clinician practice for patients fulfilling detailed inclusion and exclusion criteria. Patients with major head trauma were excluded from both studies as well as Table 3 Three clinical groupings: cardiac surgery, non-cardiac surgery, and reversal of warfarin anticoagulation Aortic valve and ascending aorta (AV-AA), thoracoabdominal aortic aneurysm (TAAA).…”

Section: Efficacy and Safety Outcomes In Non-cardiac Surgerymentioning

confidence: 99%

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Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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The use of prothrombin complex concentrates (PCCs) and fibrinogen concentrates (FIBCs) to achieve hemostasis in the perioperative setting as alternatives to allogeneic blood products remains controversial. To examine the efficacy and safety of PCCs and FIBCs, we conducted a systematic review-in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement-to compare the use of these transfusion alternatives in bleeding surgical patients. We performed a literature search of English articles published between July 1997 and July 2012 in MEDLINE via PubMed, The Cochrane Library, and CINAHL. Five randomized trials and 15 nonrandomized studies with a comparator group were included in the final review. Studies were sorted into 1 of the following 3 clinical settings: cardiac surgery, non-cardiac surgery, and reversal of warfarin anticoagulation. Risk of bias was assessed using the Cochrane risk of bias tool. With the exception of 2 randomized controlled trials, the existing body of literature on the use of PCCs and FIBCs in the perioperative setting was assessed to have a high degree of methodological bias. Overall, prospective studies in the cardiac surgery grouping suggested that patients receiving FIBC and/or PCCs required less allogeneic blood transfusion and had less chest tube drainage. In studies of warfarin reversal, PCCs more rapidly corrected the International Normalized Ratio compared to plasma; however, in the setting of intracranial hemorrhage, functional outcomes were poor regardless of the reversal strategy. With regards to safety outcomes, reporting was not uniform and raises concerns of underreporting. Adequately powered, methodologically sound trials would be required for more definitive conclusions to be drawn about the efficacy of PCCs and FIBC over conventional blood components for the treatment of perioperative coagulopathy in bleeding patients.

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Section: Non-cardiac Surgerymentioning

confidence: 99%

Section: Efficacy and Safety Outcomes In Non-cardiac Surgerymentioning

confidence: 99%

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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“…The 2016 European guidelines on management of major bleeding and coagulopathy following trauma encourages restriction in volume replacement during resuscitation and guidance by goaldirected strategies [10]. Several authors advocate the use of visco-elastic tests to guide and reduce blood product requirements during resuscitation by transfusing on the basis of specific component requirements [19,[22][23][24]. In a recent single-center, parallel-group, open-label, randomized trial, the use of fibrinogen supplementation for severe clotting failure in multiple trauma demonstrated superiority over FFP [25].…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Salib

Mohamed

Majeske

et al. 2017

Journal of the American College of Surgeons

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Background: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings.

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“…Actual studies indicate that a high amount of RBCs, FFPs and platelets can be saved without additional risks for patients by using a coagulation factor concentrate-based coagulopathy management in trauma [56]. Based upon data from four European countries (UK, Germany, Italy and Switzerland), blood substitution and blood products were calculated and found to account for approximately 27% of all costs associated with trauma care on the ICU [57].…”

Section: Coagulation Test Incl F XIII F V Inr Pt Apttmentioning

confidence: 99%

Applying ‘Patient Blood Management’ in the trauma center

Theusinger

Stein

Spahn

2014

Current Opinion in Anaesthesiology

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PURPOSE OF REVIEW: The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. RECENT FINDINGS: Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SUMMARY: Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients. Purpose of review The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. Recent findingsEarly administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SummaryApplying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.

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The impact of fresh frozen plasma vs coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion

Cited by 146 publications

References 40 publications

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Applying ‘Patient Blood Management’ in the trauma center

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