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Critical Care
Published in: Critical Care 2/2011

Open Access 01-04-2011 | Research

Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy

Authors: Herbert Schöchl, Ulrike Nienaber, Marc Maegele, Gerald Hochleitner, Florian Primavesi, Beatrice Steitz, Christian Arndt, Alexander Hanke, Wolfgang Voelckel, Cristina Solomon

Published in: Critical Care | Issue 2/2011

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Abstract

Introduction

Thromboelastometry (TEM)-guided haemostatic therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in trauma patients may reduce the need for transfusion of red blood cells (RBC) or platelet concentrate, compared with fresh frozen plasma (FFP)-based haemostatic therapy.

Methods

This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving ≥ 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission ≥2 mmol/L, injury severity score (ISS) ≥16, abbreviated injury scale for thorax and/or abdomen and/or extremity ≥3, and for head/neck < 5.

Results

For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 ± 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 ± 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69).

Conclusions

TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products.
Appendix
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Metadata
Title
Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy
Authors
Herbert Schöchl
Ulrike Nienaber
Marc Maegele
Gerald Hochleitner
Florian Primavesi
Beatrice Steitz
Christian Arndt
Alexander Hanke
Wolfgang Voelckel
Cristina Solomon
Publication date
01-04-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10078

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