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Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis

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Title: Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis
Authors: Itagaki, Yuki Browse this author
Hayakawa, Mineji Browse this author →KAKEN DB
Maekawa, Kunihiko Browse this author
Saito, Tomoyo Browse this author
Kodate, Akira Browse this author
Honma, Yoshinori Browse this author
Mizugaki, Asumi Browse this author →KAKEN DB
Yoshida, Tomonao Browse this author →KAKEN DB
Ohyasu, Takayoshi Browse this author
Katabami, Kenichi Browse this author
Wada, Takeshi Browse this author →KAKEN DB
Keywords: Cryoprecipitate
Fibrinogen concentrate
Fresh frozen plasma
Trauma-induced coagulopathy
Issue Date: 14-Jan-2020
Publisher: BioMed Central
Journal Title: World Journal of Emergency Surgery
Volume: 15
Issue: 1
Start Page: 7
Publisher DOI: 10.1186/s13017-020-0291-9
Abstract: Background Fibrinogen plays an important role in haemostasis during the early phase of trauma, and low fibrinogen levels after severe trauma are associated with haemostatic impairment, massive bleeding, and poor outcomes. Aggressive fibrinogen supplementation may improve haemostatic function, as fibrinogen levels deteriorate before other routine coagulation parameters in this setting. Therefore, we evaluated whether early administration of fibrinogen concentrate (FC) was associated with improved survival in severe trauma patients. Methods This single-centre retrospective study evaluated patients with severe trauma (injury severity score >= 16) who were admitted to our emergency department between January 2010 and July 2018. The exclusion criteria included age < 18 years, cardiac arrest before emergency department arrival, cervical spinal cord injury not caused by a high-energy accident, and severe burn injuries. The FC and control groups included trauma patients who received and did not receive FC within 1 h after emergency department arrival, respectively. Propensity scores were used to balance the two groups based on the trauma and injury severity score (TRISS), heart rate at emergency department admission, and age. The primary outcome was the in-hospital survival rate. Results The propensity scoring model had a c-statistic of 0.734, the Hosmer-Lemeshow chi-squared value was 7.036 (degrees of freedom = 8), and the non-significant p value of 0.533 indicated a good model fit. The propensity score matching created 31 matched pairs of patients, who had appropriately balanced characteristics. The FC group had a significantly higher in-hospital survival rate than the control group (log-rank p = 0.013). The FC group also used significantly higher amounts of red blood cells and fresh frozen plasma within 6 h after emergency department admission. However, the two groups had similar transfusion amounts between 6 and 24 h after emergency department admission. Conclusions The present study revealed that early FC administration was associated with a favourable survival rate among severe trauma patients. Therefore, FC may be useful for the early management of trauma-induced coagulopathy and may improve outcomes in this setting.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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