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Effect of coagulation factor concentrate administration on ROTEM® parameters in major trauma.

Ponschab M, Voelckel W, Pavelka M, Schlimp CJ, Schöchl H - Scand J Trauma Resusc Emerg Med (2015)

Bottom Line: Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT.Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM.Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF.

View Article: PubMed Central - PubMed

Affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. martin.ponschab@auva.at.

ABSTRACT

Background: Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). The impact of FC and PCC administration on ROTEM parameters among patients with TIC has not been adequately investigated.

Methods: In this retrospective observational study, changes to ROTEM parameters, induced by three different therapeutic interventions, were investigated: patients receiving FC only (FC-group); patients treated with FC and PCC (FC + PCC-group) and patients treated with PCC only (PCC-group).

Results: The study population comprised 96 patients who were predominately male (69 [71.9 %]), median age was 45.0 (26.3-60.0) years, and the median injury severity score was 34.0 (25.0-44.5). Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT. Clot amplitude (CA) increased significantly in the FIBTEM assay but remained unchanged in the EXTEM and INTEM assays. The combined administration of FC and PCC increased FIBTEM maximum clot firmness (MCF) and normalized EXTEM CT but did not change either INTEM or FIBTEM CT. Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM.

Conclusions: Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF. CT is dependent not only on thrombin generation but also on the availability of substrate (fibrinogen). Accelerated fibrin polymerisation rate results in earlier clot formation and consequently shorter CT. PCC administration normalised EXTEM CT below the upper threshold of 80 s. This study was performed at the AUVA Trauma Centre Salzburg, Salzburg, Austria.

No MeSH data available.


Related in: MedlinePlus

Changes in thromboelastometric clotting time before and after treatment with coagulation factor concentrates. CT, clotting time; EXTEM, extrinsically activated test; FC, fibrinogen concentrate; INTEM, intrinsically activated test; PCC, prothrombin complex concentrate. Values are presented as box and whiskers plots (Tukey), median (interquartile range). ns = not significant; **P < 0.01; ***P < 0.001; ****P < 0.0001
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Fig1: Changes in thromboelastometric clotting time before and after treatment with coagulation factor concentrates. CT, clotting time; EXTEM, extrinsically activated test; FC, fibrinogen concentrate; INTEM, intrinsically activated test; PCC, prothrombin complex concentrate. Values are presented as box and whiskers plots (Tukey), median (interquartile range). ns = not significant; **P < 0.01; ***P < 0.001; ****P < 0.0001

Mentions: A median dose of 4 (3–4) g FC resulted in a significant reduction in EXTEM CT (P < 0.0001) and FIBTEM CT (P = 0.0002). In contrast, FC administration had no effect on INTEM CT, which was significantly prolonged between the two measurements (P < 0.0001; Fig. 1a and Additional file 1: Table S1). Following treatment with FC, a significant increase in alpha angle in both, EXTEM and INTEM assay was observed (P < 0.0001 and P = 0.024). In addition, there was a significant increase in FIBTEM clot amplitude at 10 minutes after CT measurement (CA10; P < 0.0001). In contrast, INTEM CA10 and EXTEM CA10 remained unchanged (Additional file 1: Table S1). Furthermore, treatment with FC resulted in a significant increase in FIBTEM maximum clot firmness (MCF) from 7 to 11 mm (P < 0.0001; Fig. 2a and Additional file 1: Table S1). There was no change in either EXTEM or INTEM MCF.Fig. 1


Effect of coagulation factor concentrate administration on ROTEM® parameters in major trauma.

Ponschab M, Voelckel W, Pavelka M, Schlimp CJ, Schöchl H - Scand J Trauma Resusc Emerg Med (2015)

Changes in thromboelastometric clotting time before and after treatment with coagulation factor concentrates. CT, clotting time; EXTEM, extrinsically activated test; FC, fibrinogen concentrate; INTEM, intrinsically activated test; PCC, prothrombin complex concentrate. Values are presented as box and whiskers plots (Tukey), median (interquartile range). ns = not significant; **P < 0.01; ***P < 0.001; ****P < 0.0001
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4625604&req=5

Fig1: Changes in thromboelastometric clotting time before and after treatment with coagulation factor concentrates. CT, clotting time; EXTEM, extrinsically activated test; FC, fibrinogen concentrate; INTEM, intrinsically activated test; PCC, prothrombin complex concentrate. Values are presented as box and whiskers plots (Tukey), median (interquartile range). ns = not significant; **P < 0.01; ***P < 0.001; ****P < 0.0001
Mentions: A median dose of 4 (3–4) g FC resulted in a significant reduction in EXTEM CT (P < 0.0001) and FIBTEM CT (P = 0.0002). In contrast, FC administration had no effect on INTEM CT, which was significantly prolonged between the two measurements (P < 0.0001; Fig. 1a and Additional file 1: Table S1). Following treatment with FC, a significant increase in alpha angle in both, EXTEM and INTEM assay was observed (P < 0.0001 and P = 0.024). In addition, there was a significant increase in FIBTEM clot amplitude at 10 minutes after CT measurement (CA10; P < 0.0001). In contrast, INTEM CA10 and EXTEM CA10 remained unchanged (Additional file 1: Table S1). Furthermore, treatment with FC resulted in a significant increase in FIBTEM maximum clot firmness (MCF) from 7 to 11 mm (P < 0.0001; Fig. 2a and Additional file 1: Table S1). There was no change in either EXTEM or INTEM MCF.Fig. 1

Bottom Line: Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT.Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM.Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF.

View Article: PubMed Central - PubMed

Affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. martin.ponschab@auva.at.

ABSTRACT

Background: Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). The impact of FC and PCC administration on ROTEM parameters among patients with TIC has not been adequately investigated.

Methods: In this retrospective observational study, changes to ROTEM parameters, induced by three different therapeutic interventions, were investigated: patients receiving FC only (FC-group); patients treated with FC and PCC (FC + PCC-group) and patients treated with PCC only (PCC-group).

Results: The study population comprised 96 patients who were predominately male (69 [71.9 %]), median age was 45.0 (26.3-60.0) years, and the median injury severity score was 34.0 (25.0-44.5). Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT. Clot amplitude (CA) increased significantly in the FIBTEM assay but remained unchanged in the EXTEM and INTEM assays. The combined administration of FC and PCC increased FIBTEM maximum clot firmness (MCF) and normalized EXTEM CT but did not change either INTEM or FIBTEM CT. Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM.

Conclusions: Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF. CT is dependent not only on thrombin generation but also on the availability of substrate (fibrinogen). Accelerated fibrin polymerisation rate results in earlier clot formation and consequently shorter CT. PCC administration normalised EXTEM CT below the upper threshold of 80 s. This study was performed at the AUVA Trauma Centre Salzburg, Salzburg, Austria.

No MeSH data available.


Related in: MedlinePlus