HPE CSL Managing Perioperative Bleeding handbook - Page 23

Trauma
“ Trauma induced coagulopathy is associated with a fourfold increase in mortality ”
additional supplementation of cryoprecipitate resulted in maintenance of fibrinogen concentrations > 1.5g / l . 22
To rapidly increase plasma fibrinogen levels , European guidelines recommend either fibrinogen concentrate or cryoprecipitate if significant bleeding is accompanied by thromboelastometric signs of functional fibrinogen deficit or a fibrinogen concentration of < 1.5 – 2 g / l ( Grade 1C ). 18
Cryoprecipitate , which has been used for fibrinogen supplementation , 23 has been withdrawn in many European countries owing to significant safety concerns . 24 In a small unblinded randomised controlled trial , Curry et al reported that trauma patients receiving cryoprecipitate were able to maintain fibrinogen > 1.8g / l at all time points during active bleeding . 23
In some countries in Europe , fibrinogen concentrates have a broad label for congenital and acquired bleeding . 25 In the US , fibrinogen concentrate is licensed for bleeding episodes in patients with congenital fibrinogen deficiency only . Fibrinogen concentrate does not require thawing or cross-matching and allows rapid administration . 25 High and consistent doses of fibrinogen can be delivered in small volumes . In an emergency setting of major bleeding , injection of 6g in 1 – 2 minutes has been reported . 26 To guide dosing of fibrinogen concentrate , fibrinogen polymerisation assays , such as FIBTEM or the functional fibrinogen test , are beneficial . 27
Potential compensatory effect of fibrinogen on low platelet count Severe ongoing blood loss results not only
23 hospitalpharmacyeurope . com
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