Successful rotational thromboelastometry-guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathy.
Transfusion of allogeneic blood products is associated with increased morbidity and mortality. Therefore, strategies for reducing transfusion of these products during trauma management are valuable. We report a case of severe blunt abdominal trauma, successfully treated with antifibrinolytic medication and fibrinogen concentrate. Rotational thromboelastometry (ROTEM) was used to identify hyperfibrinolysis and afibrinogenaemia. In order to achieve haemostasis, over a 3-h period, the patient received a total of 1 g of tranexamic acid, 7 U of packed red blood cells, 16 g of fibrinogen concentrate (Haemocomplettan P), 3500 ml of colloids and 5500 ml of lactated Ringer's solution. Together with surgical measures, this treatment stopped the bleeding and stabilised the patient. There was no transfusion of either fresh-frozen plasma or platelets. The limited need for allogeneic blood products is of particular interest, and clinical studies of the approach used here appear to be warranted.
Institute of Anaesthesiology, University Hospital Zürich, Zürich, Switzerland. mirko.brenni@gmx.ch
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Brenni
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Worn
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Brüesch
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Spahn
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Ganter
D000347:Afibrinogenemia / Q000175:diagnosis / Q000188:drug therapy*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D005340:Fibrinogen / Q000032:analysis; D005342:Fibrinolysis / Q000187:drug effects*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D013916:Thrombelastography / Q000379:methods*; D014148:Tranexamic Acid / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D005340:Fibrinogen