Volume 20 Supplement 1

London Trauma and Pre-hospital Care Conference 2011

Open Access

Effect of fibrinogen concentrate on clot strength in trauma: preliminary results of an in vitro study

  • MAS Meyer1,
  • AM Sørensen2 and
  • PI Johansson1
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201220(Suppl 1):O2

DOI: 10.1186/1757-7241-20-S1-O2

Published: 22 March 2012

Background

Fibrinogen supplementation in trauma has been suggested in order to restore or improve haemostatic competence; this could possibly reduce or replace the need for transfusions in case of bleeding. Results from functional haemostatic assays indicate that lowered clot strength is associated with a risk for massive transfusions [1]. The optimal fibrinogen concentration or indications for supplementation in trauma patients have not been established [2].

Aim

To examine the in vitro effect of adding fibrinogen concentrate to whole blood from trauma patients by Thrombelastography (TEG).

Methods

Eleven patients with severe injury admitted to a Danish level 1 trauma centre were enrolled in the study. Inclusion was based on: systolic pressure < 100 mmHg and/or GCS ≤ 8 and/or substantial bleeding. Eight out of eleven patients received a transfusion within 12h after hospital admission. Mechanisms of injury included: road traffic accidents, fall injuries, and stab- and gunshot wounds. A citrated blood sample was obtained at admittance. TEG analyses were performed using both citrated kaolin (CK) and functional fibrinogen (FF). CK clot strength (maximum amplitude; MA) reflecting both the platelet and the fibrinogen contribution were compared to that of FF, which solely reflects fibrinogen contribution to clot strength. Volumes of fibrinogen concentrate equivalent to 6g*75kg-1 were added to samples prior to TEG analysis. p < 0.05 was considered significant.

Results

Fibrinogen concentrate increased the clot strength in both CK and FF assays (Fig.1). CK MA increased by 8% (p = 0.013) and FF MA by 44% (p = 0.005) after addition of fibrinogen concentrate.

Conclusions

In whole blood from trauma patients with severe injury, fibrinogen concentrate administered in a dose equivalent to 6g*75kg-1 increased clot strength significantly. These results indicate a possible pro-haemostatic effect of fibrinogen concentrate in severely injured trauma patients.

Authors’ Affiliations

(1)
Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital
(2)
Department of Anaesthesia and the Trauma Center, Center of Head and Orthopaedics, Copenhagen University Hospital

References

  1. Leemann H, Lustenberger T, Talving P, Kobayashi L, Bukur M, Brenni M, Bruesch M, Spahn DR, Keel MJ: The role of rotation thromboelastometry in early prediction of massive transfusion. J Trauma. 2010, 69 (6): 1403-1408. 10.1097/TA.0b013e3181faaa25.View ArticlePubMedGoogle Scholar
  2. Meyer MA, Ostrowski SR, Windelov NA, Johansson PI: Fibrinogen concentrates for bleeding trauma patients: what is the evidence?. Vox Sang. 2011Google Scholar

Copyright

© Meyer et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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