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Effect of fibrinogen concentrate on clot strength in trauma: preliminary results of an in vitro study
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine volume 20, Article number: O2 (2012)
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 . The optimal fibrinogen concentration or indications for supplementation in trauma patients have not been established .
To examine the in vitro effect of adding fibrinogen concentrate to whole blood from trauma patients by Thrombelastography (TEG).
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.
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.
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.
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Meyer MA, Ostrowski SR, Windelov NA, Johansson PI: Fibrinogen concentrates for bleeding trauma patients: what is the evidence?. Vox Sang. 2011
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Meyer, M., Sørensen, A. & Johansson, P. Effect of fibrinogen concentrate on clot strength in trauma: preliminary results of an in vitro study. Scand J Trauma Resusc Emerg Med 20, O2 (2012) doi:10.1186/1757-7241-20-S1-O2
- Trauma Patient
- Gunshot Wound
- Road Traffic Accident
- Massive Transfusion