Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy

Herbert Schöchl, Ulrike Nienaber, Marc Maegele, Gerald Hochleitner, Florian Primavesi, Beatrice Steitz, Christian Arndt, Alexander Hanke, Wolfgang Voelckel, Cristina Solomon, Herbert Schöchl, Ulrike Nienaber, Marc Maegele, Gerald Hochleitner, Florian Primavesi, Beatrice Steitz, Christian Arndt, Alexander Hanke, Wolfgang Voelckel, Cristina Solomon

Abstract

Introduction: Thromboelastometry (TEM)-guided haemostatic therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in trauma patients may reduce the need for transfusion of red blood cells (RBC) or platelet concentrate, compared with fresh frozen plasma (FFP)-based haemostatic therapy.

Methods: This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving ≥ 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission ≥ 2 mmol/L, injury severity score (ISS) ≥ 16, abbreviated injury scale for thorax and/or abdomen and/or extremity ≥ 3, and for head/neck < 5.

Results: For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 ± 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 ± 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69).

Conclusions: TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products.

Figures

Figure 1
Figure 1
Platelet concentrate and red blood cell (RBC) transfusion in the emergency room and during surgery. *Platelet concentrate transfusion only reported for 371 of 601 patients from the trauma registry of the German Society for Trauma Surgery (TR-DGU). FFP, fresh frozen plasma; PCC, prothrombin complex concentrate.
Figure 2
Figure 2
Percentage of patients receiving the indicated amount of haemostatic agent (FFP, fibrinogen concentrate, PCC) in the emergency room and during surgery. Percentage of patients in brackets. FFP, fresh frozen plasma; PCC, prothrombin complex concentrate.
Figure 3
Figure 3
Distribution of transfusion ratios in the FFP and fibrinogen-PCC groups (data are for treatment in the emergency room and during surgery). The line shown on each graph represents the median ratio (FFP:RBC 1; fibrinogen:RBC 0.9; PCC [in hundreds of units]:RBC 1.6). FFP, fresh frozen plasma; PCC, prothrombin complex concentrate.

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