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Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma
  1. Koji Yamamoto1,
  2. Atsushi Yamaguchi2,
  3. Makoto Sawano2,
  4. Masaki Matsuda2,
  5. Masahiro Anan1,
  6. Koichi Inokuchi2,
  7. Satoru Sugiyama2
  1. 1Department of Transfusion Medicine and Cell Therapy, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  2. 2Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  1. Correspondence to Dr Koji Yamamoto; kojiy{at}saitama-med.ac.jp

Abstract

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.

  • hemorrhage
  • hemostasis
  • transfusion
  • coagulopathy

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/

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Footnotes

  • Contributors KY analyzed the data and wrote the manuscript. AY and MM collected and analyzed the data. MA collected the data. KI and MS designed the study and analyzed the data. SS critically reviewed the manuscript. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of Saitama Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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