Fibrinogen Based Resuscitation in Trauma Induced Coagulopathy Decreases Blood-Derived Products Consumption: A Retrospective Study

Abstract

Introduction: Trauma-Induced Coagulopathy (TIC) is associated with increased early transfusion requirements, organ failure and high mortality. Fibrinogen or Fresh Frozen Plasma (FFP) based strategies are both used for its treatment. This retrospective study compares initial resuscitation strategies and its implication in consumption of (BDP) in trauma patients. Methods: Observational cohort retrospective study of patients with major trauma, admitted in a tertiary Intensive Care Unit (ICU) between 2013 and 2017 that received any BDP in the first 24 hour after admission. Primary outcome was the difference of RBC and total BDP administration at 24h between groups. Secondary outcomes were the impact of each strategy on ICU mortality, ICU length of stay and acute kidney injury. Non-parametric statistical tests were applied. Results: We included 104 trauma patients, 89% submitted to bleeding control surgery, with a median age of 46 (IQ: 31-62) and SAPSII of 39 (IQ: 26-51). Over the years of the study there was an increase in the use of fibrinogen use. Patients were subdivided into FFP (n=34) or fibrinogen group (n=70) according to the predominant use of each. The consumption of total BDP at 24h and RBC at 6h were lower in the fibrinogen group (p<0.01, p=0.05, respectively). There was a statistically difference in urea values at 24h (p=0.002), which may indicate less organ dysfunction in fibrinogen group. There was no difference in ICU mortality, although we observed an increased in ICU length in the FFP group (p=0.01). Conclusion: Compared with FFP-based treatment, the initial management with fibrinogen concentrate may decrease the consumption of total BDP at 24h after ICU admission.