Abstract
BackgroundPurified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). The impact of FC and PCC administration on ROTEM parameters among patients with TIC has not been adequately investigated.MethodsIn this retrospective observational study, changes to ROTEM parameters, induced by three different therapeutic interventions, were investigated: patients receiving FC only (FC-group); patients treated with FC and PCC (FC + PCC-group) and patients treated with PCC only (PCC-group).ResultsThe study population comprised 96 patients who were predominately male (69 [71.9 %]), median age was 45.0 (26.3–60.0) years, and the median injury severity score was 34.0 (25.0–44.5). Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT. Clot amplitude (CA) increased significantly in the FIBTEM assay but remained unchanged in the EXTEM and INTEM assays. The combined administration of FC and PCC increased FIBTEM maximum clot firmness (MCF) and normalized EXTEM CT but did not change either INTEM or FIBTEM CT. Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM.ConclusionsAdministration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF. CT is dependent not only on thrombin generation but also on the availability of substrate (fibrinogen). Accelerated fibrin polymerisation rate results in earlier clot formation and consequently shorter CT. PCC administration normalised EXTEM CT below the upper threshold of 80 s.This study was performed at the AUVA Trauma Centre Salzburg, Salzburg, Austria.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0165-4) contains supplementary material, which is available to authorized users.
Highlights
Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC)
A further 23 measurements were performed after combined treatment with FC and PCC (FC + PCC-group) and 13 pairs of measurements were completed after therapy with PCC only (PCC-group)
The current study showed that administration of FC caused higher amounts of substrate to be available for initial clot formation, resulting in a shortening of the clotting time (CT) in both the EXTEM and FIBTEM assays
Summary
Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). Trauma induced coagulopathy (TIC), which is accompanied by diffuse uncontrollable microvascular bleeding, is still associated with high mortality rate [1]. According to standard coagulation tests (SCTs), 24–34 % of trauma patients are coagulopathic at emergency room (ER) admission [2, 3]. Early and aggressive haemostatic therapy is a cornerstone of modern bleeding management and has been shown to improve survival in coagulopathic trauma patients [6, 7].
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