High-dose fibrinogen concentrate for haemostatic therapy of a major trauma patient with recent clopidogrel and aspirin intake.
BACKGROUND
We report on a severely injured trauma patient who suffered a high velocity motorcycle accident. The patient was receiving dual antiplatelet therapy with aspirin and clopidogrel.


RESULTS
Thromboelastometry (ROTEM(®)) on admission revealed low maximum clot firmness (MCF) in the FIBTEM assay, strongly indicating impaired fibrin polymerization. Inhibition of platelet activity also was confirmed. Massive intra-abdominal bleeding caused by a liver rupture required immediate laparotomy. Haemostasis during emergency surgery was achieved through topical surgical measures and intravenous fibrinogen concentrate administration (three doses of 4 g), guided by ROTEM test results only. As platelet count decreased to 28 × 10(9) L(-1), 6 h after admission to the intensive care unit, the patient received two units of platelet concentrate. No further haemostatic therapy was necessary during the next 48 h.


CONCLUSIONS
This case shows the potential effectiveness of fibrinogen concentrate in improving haemostasis in trauma patients receiving antiplatelet therapy.
Schöchl
Herbert
H
AUVA Research Centre for Traumatology, Vienna, Austria. Herbert.Schoechl@trauma.lbg.ac.at
Posch
Alexander
A
Hanke
Alexander
A
Voelckel
Wolfgang
W
Solomon
Cristina
C
D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D004347:Drug Interactions; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use*; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000188:drug therapy / Q000503:physiopathology; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013916:Thrombelastography / Q000379:methods; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy*
D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D005340:Fibrinogen; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin