Ross, Ailie, and Rudd, Donna (2019) Fibrinogen replacement in trauma patients: Effect on anticoagulant proteins antithrombin, protein C and protein S. Australian Journal of Medical Sciences, 40 (3). pp. 62-73.

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Abstract

Fibrinogen replacement in severe trauma has been shown to improve patient outcomes. Hypofibrinogenaemia is a side effect of severe trauma and fibrinogen replacement has become an important form of treatment. Major haemorrhage protocols are increasingly replacing fresh frozen plasma and cryoprecipitate with fibrinogen concentrate, largely due to convenience and speed. This study investigated the plasma levels of anticoagulant proteins following trauma in patients randomly assigned to receive either fibrinogen concentrate or cryoprecipitate. Antithrombin, protein C and protein S levels were assessed prior to fibrinogen replacement, on admission, and 6, 12, 24 and 72 hours post admission. Levels of anticoagulant proteins were low at presentation for all patients who met the clinical requirements for fibrinogen replacement. Following treatment, the cryoprecipitate group demonstrated rapid recovery, with plasma levels of anticoagulant proteins returning to the normal range by 24 hours but significant differences were seen in protein S concentrations between the treatment groups at 12 hours post ICU admission. This may suggest that fibrinogen replacement products have different effects on anticoagulant protein levels post trauma and disruptions to this balance may cause consequences for recovering patients. As fibrinogen concentrate use increases, anticoagulant protein function and risk of thromboembolic events in the longer term needs to be considered as thromboembolic events occurred in 27% of patients, demonstrating that post treatment complications are common in this cohort. The implications of this are unclear. There may be a role for combined fibrinogen replacement therapy in major haemorrhage protocols but these results suggest more research is required.

Item ID:	80237
Item Type:	Article (Research - C1)
ISSN:	1038-1643
Keywords:	coagulopathy, trauma, fibrinogen
Copyright Information:	Copyright by the Australian Institute of Medical Scientists, 2019. Full text articles are available free to the public one year after publication.
Projects and Grants:	SERTA research grant 2019_11
Date Deposited:	05 Sep 2023 00:37
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320102 Haematology @ 100%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 100%
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