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Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma
BACKGROUND: Patients with severe trauma often present with critical coagulopathy, resulting in impaired hemostasis, massive hemorrhage, and a poor survival prognosis. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion has not been studied. We assessed...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891706/ https://www.ncbi.nlm.nih.gov/pubmed/29766069 http://dx.doi.org/10.1136/tsaco-2016-000037 |
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author | Yamamoto, Koji Yamaguchi, Atsushi Sawano, Makoto Matsuda, Masaki Anan, Masahiro Inokuchi, Koichi Sugiyama, Satoru |
author_facet | Yamamoto, Koji Yamaguchi, Atsushi Sawano, Makoto Matsuda, Masaki Anan, Masahiro Inokuchi, Koichi Sugiyama, Satoru |
author_sort | Yamamoto, Koji |
collection | PubMed |
description | BACKGROUND: Patients with severe trauma often present with critical coagulopathy, resulting in impaired hemostasis, massive hemorrhage, and a poor survival prognosis. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion has not been studied. We assessed a novel approach of pre-emptive administration of fibrinogen concentrate to improve critical coagulopathy in patients with severe trauma. METHODS: We retrospectively compared blood transfusion volumes and survival prognosis between three groups of patients with trauma, with an Injury Severity Score (ISS) ≥26 over three consecutive periods: group A, no administration of fibrinogen concentrate; group B, administration of 3 g of fibrinogen concentrate after evaluation of trauma severity and a plasma fibrinogen level <1.5 g/L; group C, pre-emptive administration of 3 g of fibrinogen concentrate immediately on patient arrival based on prehospital information, including high-severity injury or assessed need for massive transfusion before measurement of fibrinogen. RESULTS: ∼56% of patients with an ISS ≥26 and transfused with red blood cell concentrates ≥10 units, had hypofibrinogenemia (fibrinogen <1.5 g/L) on arrival. Patients who received fibrinogen concentrate in group C showed significantly higher fibrinogen levels after treatment with this agent than those in group B (2.41 g/L vs 1.88 g/L; p=0.01). Although no significant difference was observed in blood transfusion volumes between the groups, the 30-day survival of patients in group C (all, and those with an ISS ≥26) was significantly better than in group A (p<0.05). The 48-hour mortality rate in patients with an ISS ≥26 was significantly lower in group C than in group A (8.6% vs 22.9%; p=0.005). Further, among patients with an ISS ≥41, the overall mortality was significantly lower in group C than in group A (20% vs 50%; p=0.02). CONCLUSION: Pre-emptive administration of fibrinogen concentrate for patients with trauma with critical coagulopathy may contribute to improved survival. LEVEL OF EVIDENCE: Level IV. |
format | Online Article Text |
id | pubmed-5891706 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58917062018-05-14 Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma Yamamoto, Koji Yamaguchi, Atsushi Sawano, Makoto Matsuda, Masaki Anan, Masahiro Inokuchi, Koichi Sugiyama, Satoru Trauma Surg Acute Care Open Original Article BACKGROUND: Patients with severe trauma often present with critical coagulopathy, resulting in impaired hemostasis, massive hemorrhage, and a poor survival prognosis. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion has not been studied. We assessed a novel approach of pre-emptive administration of fibrinogen concentrate to improve critical coagulopathy in patients with severe trauma. METHODS: We retrospectively compared blood transfusion volumes and survival prognosis between three groups of patients with trauma, with an Injury Severity Score (ISS) ≥26 over three consecutive periods: group A, no administration of fibrinogen concentrate; group B, administration of 3 g of fibrinogen concentrate after evaluation of trauma severity and a plasma fibrinogen level <1.5 g/L; group C, pre-emptive administration of 3 g of fibrinogen concentrate immediately on patient arrival based on prehospital information, including high-severity injury or assessed need for massive transfusion before measurement of fibrinogen. RESULTS: ∼56% of patients with an ISS ≥26 and transfused with red blood cell concentrates ≥10 units, had hypofibrinogenemia (fibrinogen <1.5 g/L) on arrival. Patients who received fibrinogen concentrate in group C showed significantly higher fibrinogen levels after treatment with this agent than those in group B (2.41 g/L vs 1.88 g/L; p=0.01). Although no significant difference was observed in blood transfusion volumes between the groups, the 30-day survival of patients in group C (all, and those with an ISS ≥26) was significantly better than in group A (p<0.05). The 48-hour mortality rate in patients with an ISS ≥26 was significantly lower in group C than in group A (8.6% vs 22.9%; p=0.005). Further, among patients with an ISS ≥41, the overall mortality was significantly lower in group C than in group A (20% vs 50%; p=0.02). CONCLUSION: Pre-emptive administration of fibrinogen concentrate for patients with trauma with critical coagulopathy may contribute to improved survival. LEVEL OF EVIDENCE: Level IV. BMJ Publishing Group 2016-12-02 /pmc/articles/PMC5891706/ /pubmed/29766069 http://dx.doi.org/10.1136/tsaco-2016-000037 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Original Article Yamamoto, Koji Yamaguchi, Atsushi Sawano, Makoto Matsuda, Masaki Anan, Masahiro Inokuchi, Koichi Sugiyama, Satoru Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
title | Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
title_full | Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
title_fullStr | Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
title_full_unstemmed | Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
title_short | Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
title_sort | pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891706/ https://www.ncbi.nlm.nih.gov/pubmed/29766069 http://dx.doi.org/10.1136/tsaco-2016-000037 |
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