Administration of fibrinogen concentrate for refractory bleeding in massively transfused, non-trauma patients with coagulopathy: a retrospective study with comparator group

BMC Anesthesiology

Research Article

Manuel Casado¹  José Naranjo-Izorieta¹  Reginald Dusseck¹  Santiago R Leal-Noval¹  Victoria Arellano-Orden¹  Antonio Puppo Moreno¹  Javier Bautista-Paloma²  Aurelio Cayuela³  Manuel Muñoz⁴ 

[1] Critical Care Division, Hospital Universitario “Virgen del Rocío” and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013, Seville, Spain;Pharmacy Division, Hospital Universitario “Virgen del Rocío” and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013, Seville, Spain;Statistics and Design Division, Hospital del Valme, Seville, Spain;Transfusion Medicine, University of Málaga, Málaga, Spain;

关键词: Anaemia;    Bleeding;    Clauss method;    Fibrinogen concentrate;    Goal directed therapy;    Massive transfusion protocol;    Thromboelastometry;    ROTEM;    Thromboelastography;    TEG;    FIBTEM;    Transfusion;   

DOI  :  10.1186/1471-2253-14-109

 received in 2014-08-25, accepted in 2014-11-12,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThis retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy.MethodsOver a 3-years period, all patients for whom a massive transfusion protocol was activated and had received ≥4 units of allogeneic blood components within a ≤4 h period, were included. Patients were classified according to whether they received FBNc or achieved an optimal fibrinogen level of ≥2 g/L within 24 h after FBNc administration.ResultsSeventy-one patients received 2 [2,4] g of FBNc (FBNc group) and 72 did not (comparator group). FBNc was administered after transfusing 5 [5,9] blood component units, 3 [2,6] hours after massive transfusion protocol activation. Linear regression analysis showed that SOFA (AOR 0.75 [95% CI:0.08-1.43]) and admission fibrinogen level (AOR -2.7 [95% CI:-4.68 – -0.78]), but not FBNc administration, were independently associated with total transfused units. There was a significant inverse relation between both admission and target fibrinogen levels, and total transfused components. Logistic regression showed a direct relationship between admission fibrinogen level and achieving a target level ≥2 g/L (AOR 3.29 [95% CI;1.95-5.56]). No thromboembolic events associated with FBNc were observed.ConclusionsIn massively transfused, non-trauma patients with coagulopathy and refractory bleeding, late administration of low FBNc dosage was not associated with decreased blood transfusion or increased post-infusion fibrinogen level. Given that both fibrinogen upon admission and target fibrinogen levels were associated with decreased blood transfusion, earlier administration and higher doses of FBNc could be needed.

【 授权许可】

CC BY   
© Leal-Noval et al.; licensee BioMed Central Ltd. 2014