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Fibrinogen levels during trauma hemorrhage, response to replacement therapy and association with patient outcomes.
MedLine Citation:
PMID:  22519961     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Low fibrinogen levels are known to occur in trauma. However, the extent of fibrinogen depletion during trauma hemorrhage, the response to replacement therapy and association with patient outcomes remain unclear. Objectives: The study aims were to characterize admission fibrinogen level and correlate it to factors associated with injury; describe the time course of fibrinogen depletion and response to replacement therapy; determine the correlation of fibrinogen level with ROTEM® parameters; evaluate the effect of fibrinogen supplementation ex vivo; and establish the association between fibrinogen level and clinical outcomes. Methods: This was a prospective cohort study of 517 patients. Blood samples were drawn on admission and after every 4 units of packed red blood cells. Fibrinogen levels were determined by the Clauss method and global hemostatic competence was assessed using thromboelastometry. The effect of fibrinogen supplementation was assessed in a subgroup of coagulopathic patients. Results: Low admission fibrinogen level was independently associated with ISS (p<0.01), shock (p<0.001) and pre-hospital fluid volume (p<0.001). Fibrinogen supplementation during transfusion maintained but did not augment fibrinogen levels. Administration of cryoprecipitate was associated with improved survival. ROTEM® parameters correlated with fibrinogen level and ex vivo fibrinogen administration reversed coagulopathic ROTEM® parameters. Fibrinogen level was an independent predictor of mortality at 24 hours and 28 days (p<0.001). Conclusions: Fibrinogen level is decreased in injured patients on admission and is associated with poor outcomes. ROTEM® is a rapid means of assessing hypofibrinogenemia. Earlier administration of specific fibrinogen replacement may improve outcomes and prospective controlled trials are urgently needed. © 2012 International Society on Thrombosis and Haemostasis.
Authors:
C Rourke; N Curry; S Khan; R Taylor; I Raza; R Davenport; S Stanworth; K Brohi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-20
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  -     ISSN:  1538-7836     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 International Society on Thrombosis and Haemostasis.
Affiliation:
Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London National Health Service Blood & Transplant/Haematology, John Radcliffe Hospital.
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