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  3. Medizin - Open Access LMU - Teil 17/22 Podcast
  4. Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM (R))-guided administration of fibrinogen concentrate and prothrombin complex concentrate
Introduction: The appropriate strategy for trauma-induced
coagulopathy management is under debate. We report the treatment of
major trauma using mainly coagulation factor concentrates. Methods:
This retrospective analysis included trauma patients who received
>= 5 units of red blood cell concentrate within 24 hours.
Coagulation management was guided by thromboelastometry (ROTEM(R)).
Fibrinogen concentrate was given as first-line haemostatic therapy
when maximum clot firmness (MCF) measured by FibTEM (fibrin-based
test) was < 10 mm. Prothrombin complex concentrate (PCC) was
given in case of recent coumarin intake or clotting time measured
by extrinsic activation test (EXTEM) > 1.5 times normal. Lack of
improvement in EXTEM MCF after fibrinogen concentrate
administration was an indication for platelet concentrate. The
observed mortality was compared with the mortality predicted by the
trauma injury severity score (TRISS) and by the revised injury
severity classification (RISC) score. Results: Of 131 patients
included, 128 received fibrinogen concentrate as first-line
therapy, 98 additionally received PCC, while 3 patients with recent
coumarin intake received only PCC. Twelve patients received FFP and
29 received platelet concentrate. The observed mortality was 24.4%,
lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC
mortality of 28.7% (P > 0.05). After excluding 17 patients with
traumatic brain injury, the difference in mortality was 14%
observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3%
predicted by RISC (P = 0.014). Conclusions: ROTEM(R)-guided
haemostatic therapy, with fibrinogen concentrate as first-line
haemostatic therapy and additional PCC, was goal-directed and fast.
A favourable survival rate was observed. Prospective, randomized
trials to investigate this therapeutic alternative further appear
warranted.

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„Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM (R))-guided administration of fibrinogen concentrate and prothrombin complex concentrate“

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