title: Effect of coagulation factor concentrate administration on ROTEM® parameters in major trauma.
abstract: BACKGROUND
  Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). The impact of FC and PCC administration on ROTEM parameters among patients with TIC has not been adequately investigated.
  
  
  METHODS
  In this retrospective observational study, changes to ROTEM parameters, induced by three different therapeutic interventions, were investigated: patients receiving FC only (FC-group); patients treated with FC and PCC (FC + PCC-group) and patients treated with PCC only (PCC-group).
  
  
  RESULTS
  The study population comprised 96 patients who were predominately male (69 [71.9 %]), median age was 45.0 (26.3-60.0) years, and the median injury severity score was 34.0 (25.0-44.5). Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT. Clot amplitude (CA) increased significantly in the FIBTEM assay but remained unchanged in the EXTEM and INTEM assays. The combined administration of FC and PCC increased FIBTEM maximum clot firmness (MCF) and normalized EXTEM CT but did not change either INTEM or FIBTEM CT. Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM.
  
  
  CONCLUSIONS
  Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF. CT is dependent not only on thrombin generation but also on the availability of substrate (fibrinogen). Accelerated fibrin polymerisation rate results in earlier clot formation and consequently shorter CT. PCC administration normalised EXTEM CT below the upper threshold of 80 s. This study was performed at the AUVA Trauma Centre Salzburg, Salzburg, Austria.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. martin.ponschab@auva.at.
authors.forename: Martin
authors.initials: M
authors.lastname: Ponschab
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria. Wolfgang.voelckel@auva.at.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria. michela.pavelka@auva.at.
authors.forename: Michaela
authors.initials: M
authors.lastname: Pavelka
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. christoph.schlimp@trauma.lbg.ac.at.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Schlimp
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. herbert.schoechl@auva.at.|Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria. herbert.schoechl@auva.at.
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013916:Thrombelastography; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood* / Q000628:therapy*
chemical_list: D001779:Blood Coagulation Factors