Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma

Koji Yamamoto; Atsushi Yamaguchi; Makoto Sawano; Masaki Matsuda; Masahiro Anan; Koichi Inokuchi; Satoru Sugiyama

doi:10.1136/tsaco-2016-000037

Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma

Trauma Surg Acute Care Open. 2016 Dec 2;1(1):e000037. doi: 10.1136/tsaco-2016-000037. eCollection 2016.

Authors

Koji Yamamoto¹, Atsushi Yamaguchi², Makoto Sawano², Masaki Matsuda², Masahiro Anan¹, Koichi Inokuchi², Satoru Sugiyama²

Affiliations

¹ Department of Transfusion Medicine and Cell Therapy, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
² Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.

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.

Keywords: coagulopathy; hemorrhage; hemostasis; transfusion.