title: The exclusive use of coagulation factor concentrates enables reversal of coagulopathy and decreases transfusion rates in patients with major blunt trauma.
abstract: BACKGROUND
  FFP and coagulation factor concentrates are used to correct trauma-induced coagulopathy (TIC). However, data on coagulation profiles investigating effects of therapy are scarce.
  
  
  METHODS
  This is an analysis of 144 patients with major blunt trauma ((ISS)≥15), who were enrolled in a prospective cohort study investigating characteristics and treatment of TIC. Patients who received fibrinogen concentrate and/or prothrombin complex concentrate alone (CF Group) were compared with those additionally receiving FFP transfusions (FFP Group).
  
  
  RESULTS
  Sixty-six patients exclusively received CF, while 78 patients additionally received FFP. Overall, patients were comparable regarding age, gender and ISS (CF Group, ISS 37 (29, 50); FFP Group ISS 38 (33, 55), p=0.28). Patients treated with CF alone showed sufficient haemostasis and received significantly fewer units of red blood cells (RBC) and platelets than did those also receiving FFP [(RBC 2(0, 4) U vs. 9 (5, 12) U; platelets 0 (0, 0) U vs. 1 (0, 2) U, p<0.001)]. In addition, fewer patients in the CF Group developed multiorgan failure (MOF) (18.2% vs. 37.2%, p=0.01) or sepsis (16.9% vs. 35.9%, p=0.014) than in the FFP Group. Propensity score-matching (n=28 pairs) used to reduce the impact of treatment selection confirmed that additional FFP administration showed no benefit in restoring haemostasis, but was associated with significantly higher transfusion rates for RBC and platelets.
  
  
  CONCLUSIONS
  The use of CF alone effectively corrected coagulopathy in patients with severe blunt trauma and concomitantly decreased exposure to allogeneic transfusion, which may translate into improved outcome.
authors.affiliation: Clinic of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Innerhofer
authors.forename: Isabella
authors.initials: I
authors.lastname: Westermann
authors.forename: Helmuth
authors.initials: H
authors.lastname: Tauber
authors.forename: Robert
authors.initials: R
authors.lastname: Breitkopf
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fries
authors.forename: Tobias
authors.initials: T
authors.lastname: Kastenberger
authors.forename: Rene
authors.initials: R
authors.lastname: El Attal
authors.forename: Alexander
authors.initials: A
authors.lastname: Strasak
authors.forename: Markus
authors.initials: M
authors.lastname: Mittermayr
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D016913:Blood Component Transfusion / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D010976:Platelet Count; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D005340:Fibrinogen