Due to their low volume of administration, coagulation factor concentrates are also likely to have a smaller effect on haematocrit. The use of TEM to diagnose coagulopathy may additionally help reduce RBC and platelet concentrate transfusion. There is increasing evidence of the usefulness of viscoelastic methods for diagnosing trauma-induced coagulopathy [12,27-29], and FTY720 Multiple Sclerosis several reports have described a reduction in transfusion requirements following its introduction to treatment algorithms [30-32].Our approach to managing coagulopathy in trauma patients focuses on the use of fibrinogen concentrate and PCC, which are quicker to administer than allogeneic blood products. Several groups have suggested that reducing the time to administer haemostatic therapy may improve patient outcomes [8-10].
Our group recently described an algorithm of goal-directed coagulation therapy with fibrinogen and PCC in major trauma patients [12], and in that study 52% of patients received the first dose of fibrinogen concentrate within the first hour, most of them within 30 minutes. In contrast, in a study published by Snyder et al., the first unit of FFP was typically administered at a median of 93 minutes after arrival at the ER [8]. Such delay may be related to the need for blood group matching, thawing and warming of FFP before administration (thawing and warming usually take about 30 minutes). It may be possible to address this delay, for example by storing thawed plasma for immediate application [33]. The use of pre-defined transfusion packages has also been described [34].
Most trauma centres use defined transfusion packages containing cooled RBC and frozen or thawed FFP. Unfortunately, thawing FFP in advance may have negative consequences, because unused thawed units must be discarded. To reduce apparent wastage, physicians may be tempted to overuse FFP. This tendency must be considered in the context of today’s economic and administrative pressures, because the costs of blood products are high and often underestimated [35]. The time to infuse medication is another consideration. In general, it is recommended that one unit of FFP is administered over a period of about 30 minutes. In contrast, typical doses of fibrinogen concentrate and PCC may be administered in less than 10 minutes [16,36], and plasma levels of the coagulation factors administered rise rapidly after infusion.
This study was not designed to establish whether TEM-guided haemostatic therapy with fibrinogen concentrate and PCC improves mortality. Large numbers of patients would be required to provide statistically Anacetrapib robust evidence on mortality [37]. We nevertheless report an encouraging trend towards lower mortality in the fibrinogen-PCC group compared with the FFP group: 7.5% versus 10.0% (P = 0.69).