Fibrinogen replacement in trauma haemorrhage

Excerpt

There is a growing interest in the role that fibrinogen plays in major haemorrhage. It has been known since 1995 that fibrinogen is one of the first coagulation proteins to fall to critically low levels during major blood loss [1], but the clinical relevance of this is only now being evaluated. Injury is the leading cause of death worldwide for patients aged 1-45 and accounts for 7,800 deaths in UK annually. Uncontrolled haemorrhage is the most common treatable cause of death in this population; four out of every ten trauma patients die as a result of exsanguination, or its late effects. Most trauma deaths from haemorrhage occur within the first six hours of hospital admission and early control of bleeding may have a significant impact on mortality. By increasing understanding of the precipitants of uncontrolled bleeding (i.e. acute traumatic coagulopathy) and targeting therapy accordingly, it is expected that major haemorrhage therapy and more importantly, clinical outcomes, can be further improved. This short review briefly evaluates what is known about fibrinogen during major trauma haemorrhage, focusing on the changes that take place during traumatic coagulopathy and the role that fibrinogen supplementation may play in treatment of trauma haemorrhage. …