Abstract
Coagulation complications are significant contributors to morbidity and mortality in trauma patients. Although the lethal triad of hypothermia, acidosis and coagulopathy has been recognized for over a decade, the underlying mechanisms related to the development of coagulopathy remain unclear. Recent data suggest that decreased fibrinogen levels contribute to the development of coagulation disorders. Thus, regulation of fibrinogen availability, not fully understood at present, may play an important role in survival of trauma patients. This review summarizes the recent findings of the studies that have explored mechanisms related to changes in fibrinogen availability following trauma-related events. Trauma alters fibrinogen metabolism in a variety of ways: hemorrhage – accelerated fibrinogen breakdown; hypothermia – inhibited fibrinogen synthesis; and, acidosis – accelerated fibrinogen breakdown. However, hemorrhage, hypothermia andcidosis all result in a consistent outcome of fibrinogen availability deficit, supporting the notion of fibrinogen supplementation in trauma patients with coagulation defects. Future prospective clinical trials are needed to confirm the beneficial effects of fibrinogen supplementation in trauma patients with bleeding complications.
Highlights
Coagulation complications are significant contributors to morbidity and mortality in trauma patients [1,2]
Data from this study showed that after moderate hemorrhage, fibrinogen breakdown was accelerated compared with the control group
There were no significant differences in fibrinogen synthesis among the control group (2.5 ± 0.6 mg/kg/h), the hemorrhage only group (1.7 ± 0.3 mg/kg/h) or the hemorrhage-lactated Ringers solution (LR) resuscitation group (2.6 ± 0.4 mg/kg/h, Additional file 1)
Summary
Coagulation complications are significant contributors to morbidity and mortality in trauma patients [1,2]. The simultaneous and independent quantification of synthesis and breakdown provides comprehensive and complete assessment of fibrinogen metabolism and availability This methodology involves the infusion of stable isotope labeled amino acids with subsequent gas chromatography mass spectrometry analysis. Stable isotopes are naturally occurring and safe for use in humans; second, synthesis and breakdown rates are quantified simultaneously and independently in the same subject; and third, the entire study (infusion and blood samplings) takes only 6 to 8 hours, compared to the days required in previous approaches The establishment of this methodology made it possible to investigate changes of fibrinogen metabolism in trauma. Following gas chromatograph and mass spectrometry analysis, data from this study showed that, in contrast to the effects of hypothermia, acidosis increased fibrinogen breakdown by 1.8-fold compared with control values, with no effects on fibrinogen synthesis (Additional file 1) [54]. Future prospective clinical trials are needed to clarify the effects of a higher ratio of fibrinogen to RBC transfusion and outcome in trauma patients
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