concentrate first line, PCC and FXIII)
replacement in a cohort of major trauma
patients. Significantly fewer patients in
the coagulation factor concentrate group
received massive transfusion and fewer
patients received ‘rescue’ therapy by
changing the treatment groups. However,
the primary outcome, which was
multi-organ failure, was not different
between groups (the study was stopped at
50% recruitment). 8 One study compared
a ROTEM-guided coagulation therapy
based on coagulation factor concentrates
(fibrinogen concentrate and PCC) with
controls from the German Trauma
Registry, treated with FFP. RBC and PC
transfusions were avoided in significantly
higher proportions of patients in the
coagulation factor concentrate group.
However, no difference in mortality was
It remains unclear whether early
substitution of coagulation factor
concentrate can improve outcome in
major trauma-related bleeding. However,
it has been clearly established that
coagulation factor concentrates allow
rapid and targeted supplementation of
pro-coagulants, and that the
administration of fibrinogen concentrate
in cases of TIC effectively treats early and
critical fibrinogen depletion. Thus,
fibrinogen concentrate confers significant
advantages in both safety and speed of
administration over FFP transfusion for
supplementation of fibrinogen. In
addition, PCCs effectively increase the
content of vitamin K-dependent
coagulation factors and is clearly superior
compared with FFP transfusion.
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