Comparison of the effects of fibrinogen concentrates and fresh frozen plasma in patients with acute traumatic coagulopathy
A quasi-experimental study compared the effectiveness of fibrinogen concentrates and fresh frozen plasma in patients with severe blunt trauma requiring the administration of erythrocyte replacements.
Introduction
Acute traumas are among the common causes of death in younger individuals, with a significant portion resulting from unmanageable bleeding due to acute traumatic coagulopathy. This, alongside the trauma itself, is a primary factor in the development of irreversible hemorrhagic shock. Preventing and treating acute traumatic coagulopathy is thus a crucial part of the comprehensive care that improves the prognosis for patients with severe trauma.
Currently, there is ongoing debate about the effectiveness of replacing coagulation factors in patients with acute traumatic coagulopathy who require erythrocyte concentrates. This quasi-experimental study compared therapeutic outcomes in patients treated with fibrinogen concentrates or fresh frozen plasma.
Study Course and Evaluated Population
The quasi-experimental randomized controlled clinical study included patients with severe blunt trauma (ISS score > 16) requiring transfusion therapy in the form of erythrocyte concentrates. Patients were divided into 3 therapeutic groups: the first group received fibrinogen concentrates, the second group fresh frozen plasma, and the third group served as the control population.
A total of 90 patients participated in the study (82.2% of the population were men), with an average age of 33.16 ± 16.32 years. Baseline characteristics were similar across the groups.
Findings
Patients undergoing fibrinogen concentrate therapy required significantly fewer erythrocyte concentrates (p = 0.022) and intravenous solutions during the first 24 hours of hospitalization (p = 0.022). This group also showed lower mortality rates (p = 0.029), less need for intensive care admission (p = 0.020), and shorter hospitalization durations (p = 0.045).
The incidence of sepsis was lower in the fibrinogen-treated group and control group compared to those receiving fresh frozen plasma (p = 0.001). The incidence of multi-organ failure was about a quarter in the fibrinogen group compared to the other groups (p = 0.106). Fewer patients receiving fibrinogen concentrate required mechanical ventilation (p = 0.191). No venous thromboembolism development was observed in any group during the study.
Conclusion
The study results indicated that administering fibrinogen concentrates in patients with severe blunt trauma requiring erythrocyte concentrate therapy led to significant improvements in parameters such as mortality, sepsis, need for intensive care, length of hospitalization, erythrocyte concentrate therapy, and intravenous solutions during the first 24 hours of hospitalization.
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Source: Akbari E., Safari S., Hatamabadi H. The effect of fibrinogen concentrate and fresh frozen plasma on the outcome of patients with acute traumatic coagulopathy: a quasi-experimental study. Am J Emerg Med 2018; 36 (11): 1947–1950, doi: 10.1016/j.ajem.2018.02.018.
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