title: Fibrinogen and prothrombin complex concentrate in trauma coagulopathy.
abstract: BACKGROUND
  Coagulopathy after injury contributes to hemorrhage and death. Treatment with specific coagulation factors could decrease hemorrhage and mortality. Our aim was to compare fibrinogen and prothrombin complex concentrate (PCC) in a rabbit model of hemorrhagic shock.
  
  
  METHODS
  New Zealand white rabbits were anesthetized. Blood was withdrawn to a mean arterial pressure (MAP) of 30-40 mm Hg for 30 min. Animals were resuscitated with lactated Ringer to a MAP of 50-60 mm Hg and randomized to receive 100 mg/kg of fibrinogen, PCC 25 IU/kg, or lactated Ringer. A liver injury was created. A MAP of 50-60 mm Hg was maintained for 60 min. The primary outcome was blood loss, and secondary outcomes were fluid administered and coagulopathy as measured by plasma-based tests.
  
  
  RESULTS
  There were eight animals in each group. Median blood loss was significantly higher in the fibrinogen group, at 122 mL (95% confidence interval [CI], 75-194), when compared with that in the control group, 35 mL (95% CI, 23-46; P value = 0.001), and the PCC group, 26 mL (95% CI, 4-54; P value = 0.002). Resuscitation fluid requirement was highest in the fibrinogen group, at 374 mL (95% CI, 274-519), and lowest in the PCC group, at 238 mL (95% CI, 212-309) (P = 0.01). Plasma-based coagulation tests were not different among groups.
  
  
  CONCLUSIONS
  In a rabbit model, PCC did not have a significant effect on blood loss. Fibrinogen increased blood loss and fluid requirements.
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, California. Electronic address: matthew.hannon@med.navy.mil.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hannon
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, California.
authors.forename: Jacob
authors.initials: J
authors.lastname: Quail
authors.affiliation: Clinical Investigation Department, Naval Medical Center, San Diego, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Clinical Investigation Department, Naval Medical Center, San Diego, California.
authors.forename: Cara
authors.initials: C
authors.lastname: Pugliese
authors.affiliation: Clinical Investigation Department, Naval Medical Center, San Diego, California.
authors.forename: Kejian
authors.initials: K
authors.lastname: Chen
authors.affiliation: Clinical Investigation Department, Naval Medical Center, San Diego, California.
authors.forename: Heidi
authors.initials: H
authors.lastname: Shorter
authors.affiliation: Clinical Investigation Department, Naval Medical Center, San Diego, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Riffenburgh
authors.affiliation: Clinical Investigation Department, Naval Medical Center, San Diego, California.
authors.forename: Ronald
authors.initials: R
authors.lastname: Jackson
mesh_terms: D000818:Animals; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D004353:Drug Evaluation, Preclinical; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D005440:Fluid Therapy; D008099:Liver / Q000293:injuries*; D011817:Rabbits; D011897:Random Allocation; D012771:Shock, Hemorrhagic / Q000150:complications* / Q000628:therapy
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D005340:Fibrinogen
keywords: Animal model; Fibrinogen; Hemorrhagic shock; Prothrombin complex concentrate; Trauma coagulopathy