The early use of fibrinogen, prothrombin complex concentrate, and recombinant‐activated factor VIIa in massive bleeding

Abstract

Coagulopathy related to massive bleeding has a multifactorial aetiology. Coagulopathy is related to shock and blood loss including consumption of clotting factors and platelets and hemodilution. Additionally hyperfibrinolysis, hypothermia, acidosis, and metabolic changes affect the coagulation system. The aim of any hemostatic therapy is to control bleeding and minimize blood loss and transfusion requirements. Transfusion of allogeneic blood products as well as the presence of coagulopathy cause increased morbidity and mortality. This paper presents a short review on new treatment strategies of coagulopathy, related to massive blood loss. Paradigms are actively changing and there is still shortage of data. However, there is increasing experience and evidence that "target controlled algorithms" using point-of-care monitoring devices and coagulation factor concentrates are more effective compared to transfusion of fresh frozen plasma, independently of the individual clinical situation. Future treatment of coagulopathy associated with massive bleeding can be based on an individualized point-of-care guided rational use of coagulation factor concentrates such as fibrinogen, prothrombin complex concentrate, and recombinant factor VIIa. The timely and rational use of coagulation factor concentrates may be more efficacious and safer than ratio-driven use of transfusion packages of allogeneic blood products.