title: Fibrinogen levels in trauma patients during the first seven days after fibrinogen concentrate therapy: a retrospective study.
abstract: BACKGROUND
  Fibrinogen concentrate (FC) is increasingly used as first line therapy in bleeding trauma patients. It remains unproven whether FC application increases post-traumatic plasma fibrinogen concentration (FIB) in injured patients, possibly constituting a prothrombotic risk. Thus, we investigated the evolution of FIB following trauma in patients with or without FC therapy.
  
  
  METHODS
  At the AUVA Trauma Centre, Salzburg, we performed a retrospective study of patients admitted to the emergency room and whose FIB levels were documented thereafter up to day 7 post-trauma. Patients were categorized into those with (treatment group) or without (control group) FC therapy during the first 24 h after hospital admission. A subgroup analysis was carried out to investigate the influence of the amount of FC given.
  
  
  RESULTS
  The study enrolled 435 patients: treatment group, n = 242 (56 %); control group, n = 193 (44%), with median Injury Severity Score of 34 vs. 22 (P < 0.001) and massive transfusion rate of 18.4% vs. 0.2% (P < 0.001). In the treatment group (median FC dose 6 g), FIB was lower on admission and up to day 2 compared with the control group. In patients receiving high (≥10 g) doses of FC, FIB was lower up to day 5 as compared to controls. At other timepoints, FIB did not differ significantly between the groups. In the treatment vs. the control group, other coagulation parameters such as prothrombin time index and platelet count were consistently lower, while activated partial thromboplastin time was consistently prolonged at most timepoints. Inflammatory parameters such as C-reactive protein, interleukin-6 and procalcitonin were generally lower in controls.
  
  
  CONCLUSIONS
  The rise of FIB levels from day 2 onwards in our study can be attributed to an upregulated fibrinogen synthesis in the liver, occurring in both study groups as part of the acute phase response after tissue injury.
  
  
  CONCLUSIONS
  The treatment of severe trauma patients with FC during bleeding management in the first 24 h after hospital admission does not lead to higher FIB levels post-trauma beyond that occurring naturally due to the acute phase response.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria.
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.
authors.forename: Martin
authors.initials: M
authors.lastname: Ponschab
authors.affiliation: Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
authors.affiliation: Department of Anaesthesiology and Intensive Care, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Treichl
authors.affiliation: Department of Traumatology, Orthopedic Surgery and Sports Medicine Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), Cologne, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
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, AUVA Trauma Centre, 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; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage* / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood*; D055815:Young Adult
chemical_list: D005340:Fibrinogen
keywords: Blood coagulation tests; Fibrinogen; Plasma; Trauma