Variations and obstacles in the use of coagulation factor concentrates for major trauma bleeding across Europe: outcomes from a European expert meeting
| Autor: | Gábor Nardai, Anders Östlund, Marc Maegele, Dietmar Fries, Herbert Schöchl, Vladimir Černý, Vanessa Agostini, Santiago R. Leal-Noval, Giuseppe Nardi |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
congenital hereditary and neonatal diseases and abnormalities Hemorrhage Review Article 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Hemostatics 03 medical and health sciences 0302 clinical medicine Low fibrinogen mental disorders Coagulopathy medicine Humans Orthopedics and Sports Medicine Intensive care medicine business.industry Major trauma Critical factors Bleeding Fibrinogen 030208 emergency & critical care medicine Trauma-induced coagulopathy Blood Coagulation Disorders medicine.disease Blood Coagulation Factors Coagulation Tranexamic Acid Expert opinion Coagulation factor concentrates Fibrinogen concentrate Emergency Medicine Surgery Fresh frozen plasma business Tranexamic acid Major bleeding medicine.drug |
| Zdroj: | European Journal of Trauma and Emergency Surgery |
| Popis: | Purpose Trauma is a leading cause of mortality, with major bleeding and trauma-induced coagulopathy (TIC) contributing to negative patient outcomes. Treatments for TIC include tranexamic acid (TXA), fresh frozen plasma (FFP), and coagulation factor concentrates (CFCs, e.g. prothrombin complex concentrates [PCCs] and fibrinogen concentrate [FCH]). Guidelines for TIC management vary across Europe and a clear definition of TIC is still lacking. Methods An advisory board involving European trauma experts was held on 02 February 2019, to discuss clinical experience in the management of trauma-related bleeding and recommendations from European guidelines, focusing on CFC use (mainly FCH). This review summarises the discussions, including TIC definitions, gaps in the guidelines that affect their implementation, and barriers to use of CFCs, with suggested solutions. Results A definition of TIC, which incorporates clinical (e.g. severe bleeding) and laboratory parameters (e.g. low fibrinogen) is suggested. TIC should be treated immediately with TXA and FCH/red blood cells; subsequently, if fibrinogen ≤ 1.5 g/L (or equivalent by viscoelastic testing), treatment with FCH, then PCC (if bleeding continues) is suggested. Fibrinogen concentrate, and not FFP, should be administered as first-line therapy for TIC. Several initiatives may improve TIC management, with improved medical education of major importance; generation of new and stronger data, simplified clinical practice guidance, and improved access to viscoelastic testing are also critical factors. Conclusions Management of TIC is challenging. A standard definition of TIC, together with initiatives to facilitate effective CFC administration, may contribute to improved patient care and outcomes. |
| Databáze: | OpenAIRE |
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