title: Evaluation of the efficiency under current use of human fibrinogen concentrate in trauma patients with life-threatening hemorrhagic disorders.
abstract: The aim of the study was to assess the influence of fibrinogen concentrate on survival when it is used in trauma patients with life-threatening hemorrhagic disorders. Secondly, to evaluate when the fibrinogen concentrate administration maximizes its efficacy, and to describe what other concomitant treatment the patients received in order to control their life-threatening hemorrhage. Retrospective, observational, and multicenter study was carried out in three trauma areas between June 2012 and June 2014. The totality of trauma patients with a documented life-threatening hemorrhage who received a fibrinogen concentrate prescription was included in the study. Demographic and analytical data, admission diagnosis, treatment indication, fibrinogen concentrate dose, survival after 1 and 7 days, hospitalization time, and concomitant blood product treatment were collected. One hundred and twenty-three patients were finally included. The mean dose of fibrinogen concentrate administered was 2.87 g. The mean initial fibrinogen plasma level was 1.49 g/l, which rose to 2.26 g/l. The number of patients who survived after 24 h was 80.49%, and 69.11% after 7 days. Lower fibrinogen plasma levels are statistically associated with a higher probability of death after 7 days (P = 0.004). The most suitable threshold to recommend the fibrinogen concentrate administration has been found to be 1.5 g/dl (P = 0006, after 24 h; P = 0.032, after 7 days). Finally, the most common concomitant treatment was the erythrocytes concentrate. A statistically significant relationship between lower fibrinogen plasma levels and a higher probability of death after 7 days has been found. Our data support the threshold of 1.5 g/l as the recommended level to administer fibrinogen concentrate in trauma patients.
authors.affiliation: aPharmacy Service, Universitary Hospital of Vall d'Hebron bPharmacy Service, Universitary Hospital of Bellvitge, Barcelona, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: González-Guerrero
authors.forename: Toni
authors.initials: T
authors.lastname: Lozano-Andreu
authors.forename: Maria
authors.initials: M
authors.lastname: Roch-Santed
authors.forename: Lucas
authors.initials: L
authors.lastname: Rivera-Sánchez
authors.forename: David
authors.initials: D
authors.lastname: Brandariz-Núñez
authors.forename: Lourdes
authors.initials: L
authors.lastname: Pastó-Cardona
authors.forename: Juan C
authors.initials: JC
authors.lastname: Juárez-Giménez
authors.forename: Jose B
authors.initials: JB
authors.lastname: Montoro-Ronsano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000627:therapeutic use*; D006474:Hemorrhagic Disorders / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D005340:Fibrinogen