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Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate
INTRODUCTION: The appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates. METHODS: This retrospective analysis included trauma patients who received ≥ 5 units of red blood cell concentrate...
Autores principales: | , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887173/ https://www.ncbi.nlm.nih.gov/pubmed/20374650 http://dx.doi.org/10.1186/cc8948 |
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author | Schöchl, Herbert Nienaber, Ulrike Hofer, Georg Voelckel, Wolfgang Jambor, Csilla Scharbert, Gisela Kozek-Langenecker, Sibylle Solomon, Cristina |
author_facet | Schöchl, Herbert Nienaber, Ulrike Hofer, Georg Voelckel, Wolfgang Jambor, Csilla Scharbert, Gisela Kozek-Langenecker, Sibylle Solomon, Cristina |
author_sort | Schöchl, Herbert |
collection | PubMed |
description | INTRODUCTION: The appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates. METHODS: This retrospective analysis included trauma patients who received ≥ 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM(®)). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score. RESULTS: Of 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014). CONCLUSIONS: ROTEM(®)-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted. |
format | Text |
id | pubmed-2887173 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-28871732010-06-18 Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate Schöchl, Herbert Nienaber, Ulrike Hofer, Georg Voelckel, Wolfgang Jambor, Csilla Scharbert, Gisela Kozek-Langenecker, Sibylle Solomon, Cristina Crit Care Research INTRODUCTION: The appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates. METHODS: This retrospective analysis included trauma patients who received ≥ 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM(®)). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score. RESULTS: Of 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014). CONCLUSIONS: ROTEM(®)-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted. BioMed Central 2010 2010-04-07 /pmc/articles/PMC2887173/ /pubmed/20374650 http://dx.doi.org/10.1186/cc8948 Text en Copyright ©2010 Schöchl et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Schöchl, Herbert Nienaber, Ulrike Hofer, Georg Voelckel, Wolfgang Jambor, Csilla Scharbert, Gisela Kozek-Langenecker, Sibylle Solomon, Cristina Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
title | Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
title_full | Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
title_fullStr | Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
title_full_unstemmed | Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
title_short | Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
title_sort | goal-directed coagulation management of major trauma patients using thromboelastometry (rotem(®))-guided administration of fibrinogen concentrate and prothrombin complex concentrate |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887173/ https://www.ncbi.nlm.nih.gov/pubmed/20374650 http://dx.doi.org/10.1186/cc8948 |
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