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The European Perspective on the Management of Acute Major Hemorrhage and Coagulopathy after Trauma: Summary of the 2019 Updated European Guideline
Article

First-Line Administration of Fibrinogen Concentrate in the Bleeding Trauma Patient: Searching for Effective Dosages and Optimal Post-Treatment Levels Limiting Massive Transfusion—Further Results of the RETIC Study

1
Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
2
Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, 6020 Innsbruck, Austria
*
Author to whom correspondence should be addressed.
Collaborators in the RETIC Study group are provided in the Acknowledgments.
Academic Editor: Michael Christ
J. Clin. Med. 2021, 10(17), 3930; https://doi.org/10.3390/jcm10173930
Received: 18 July 2021 / Revised: 23 August 2021 / Accepted: 25 August 2021 / Published: 31 August 2021
Fibrinogen supplementation is recommended for treatment of severe trauma hemorrhage. However, required dosages and aimed for post-treatment fibrinogen levels remain a matter of discussion. Within the published RETIC study, adult patients suffering trauma-induced coagulopathy were randomly assigned to receive fibrinogen concentrate (FC) as first-line (n = 50) or crossover rescue (n = 20) therapy. Depending on bodyweight, a single dose of 3, 4, 5, or 6 g FC was administered and repeated if necessary (FibA10 < 9 mm). The dose-dependent response (changes in plasma fibrinogen and FibA10) was analyzed. Receiver operating characteristics (ROC) analysis regarding the need for massive transfusion and correlation analyses regarding fibrinogen concentrations and polymerization were performed. Median FC single doses amounted to 62.5 (57 to 66.66) mg.kg1. One FC single-dose sufficiently corrected fibrinogen and FibA10 (median fibrinogen 213 mg.dL−1, median FibA10 11 mm) only in patients with baseline fibrinogen above 100 mg.dL−1 and FibA10 above 5 mm, repeated dosing was required in patients with lower baseline fibrinogen/FibA10. Fibrinogen increased by 83 or 107 mg.dL−1 and FibA10 by 4 or 4.5 mm after single or double dose of FC, respectively. ROC curve analysis revealed post-treatment fibrinogen levels under 204.5 mg.dL1 to predict the need for massive transfusion (AUC 0.652; specificity: 0.667; sensitivity: 0.688). Baseline fibrinogen/FibA10 levels should be considered for FC dosing as only sufficiently corrected post-treatment levels limit transfusion requirements. View Full-Text
Keywords: fibrinogen concentrate; fibrinogen plasma; massive transfusion; trauma induced coagulopathy; rotational thromboelastometry fibrinogen concentrate; fibrinogen plasma; massive transfusion; trauma induced coagulopathy; rotational thromboelastometry
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MDPI and ACS Style

Innerhofer, N.; Treichl, B.; Rugg, C.; Fries, D.; Mittermayr, M.; Hell, T.; Oswald, E.; Innerhofer, P.; on behalf of the RETIC Study Group. First-Line Administration of Fibrinogen Concentrate in the Bleeding Trauma Patient: Searching for Effective Dosages and Optimal Post-Treatment Levels Limiting Massive Transfusion—Further Results of the RETIC Study. J. Clin. Med. 2021, 10, 3930. https://doi.org/10.3390/jcm10173930

AMA Style

Innerhofer N, Treichl B, Rugg C, Fries D, Mittermayr M, Hell T, Oswald E, Innerhofer P, on behalf of the RETIC Study Group. First-Line Administration of Fibrinogen Concentrate in the Bleeding Trauma Patient: Searching for Effective Dosages and Optimal Post-Treatment Levels Limiting Massive Transfusion—Further Results of the RETIC Study. Journal of Clinical Medicine. 2021; 10(17):3930. https://doi.org/10.3390/jcm10173930

Chicago/Turabian Style

Innerhofer, Nicole, Benjamin Treichl, Christopher Rugg, Dietmar Fries, Markus Mittermayr, Tobias Hell, Elgar Oswald, Petra Innerhofer, and on behalf of the RETIC Study Group. 2021. "First-Line Administration of Fibrinogen Concentrate in the Bleeding Trauma Patient: Searching for Effective Dosages and Optimal Post-Treatment Levels Limiting Massive Transfusion—Further Results of the RETIC Study" Journal of Clinical Medicine 10, no. 17: 3930. https://doi.org/10.3390/jcm10173930

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