The quantity of fibrinogen administered may also affect mortality rates. Stinger et al. reported correlations between the amount of fibrinogen Paclitaxel human endothelial cells administered and blood loss and survival in severely bleeding patients from the Iraq war . Successful haemostatic therapy with fibrinogen concentrate has been described in other settings involving extensive surgery and blood loss (e.g., cardiovascular surgery) [39-41]. Successful use of PCC to treat acquired coagulopathy in the perioperative setting has previously been reported, albeit in limited numbers of patients [11,12,42,43]. Animal experiments have suggested that PCC may be more effective than FFP in the trauma setting , whereas Austrian guidelines recommend PCC administration in bleeding patients if clotting time measured by thrombelastography (TEG)/TEM is prolonged .
In the present study, PCC was administered to treat bleeding when clotting time in the EXTEM assay was prolonged.The study inclusion criteria aimed at minimise between-group differences in patient characteristics. The choice of 1 g fibrinogen/500 U PCC as inclusion criteria was based on practical therapy. The minimum amount of fibrinogen concentrate administered in clinical practice is 1 g, and patients from the STC were eligible for inclusion in the study once they had received this dose. Similarly, the minimum dose of PCC was 500 U. We chose 2 units of FFP as the criterion for the comparator group because this dose should contain approximately 1 g of fibrinogen , thus enabling comparison with the fibrinogen-PCC group.
The data analysis revealed some between-group differences in patient characteristics, and these are worthy of consideration. Although ISS, TRISS, RISC and AIS for abdomen and extremity were not significantly different, there was a significant trend towards more severe head and chest trauma in the FFP-group. Surprisingly, however, the score predicting massive transfusion (TASH) was higher in the fibrinogen-PCC group. Furthermore, it is difficult to estimate whether trauma-induced coagulopathy related to hypoperfusion was more pronounced in either of these two groups. On the one hand, blood pressure was significantly lower in the fibrinogen-PCC group, and base deficit was non-significantly lower in this group. On the other hand, both PT (expressed as a percentage) and platelet count were higher in the FFP group (P not significant for platelet count).
Had hypoperfusion been more pronounced in the fibrinogen-PCC group, the GSK-3 significantly lower transfusion rates would appear even more encouraging.The present study has several limitations. Data for the fibrinogen-PCC group were collected retrospectively from only one centre. TR-DGU data are collected via standardised forms from trauma centres throughout central Europe.