Low fibrinogen levels after severe trauma are associated with haemostatic impairment, massive bleeding, and poor outcomes. Fibrinogen supplementation is able to improve haemostatic function, the early administration of fibrinogen concentrate (FC) has here been associated with improved survival in severe trauma patients.A single-centre retrospective study evaluated patients with severe trauma. The exclusion criteria included age < 18 years, cardiac arrest before emergency department arrival, cervical spinal cord injury not caused by a high-energy accident, and severe burn injuries. The FC and control groups included trauma patients who received and did not receive FC within 1 h after emergency department arrival, respectively. Propensity scores were used to balance the two groups based on the trauma and injury severity score (TRISS), heart rate at emergency department admission, and age. The primary outcome was the in-hospital survival rate.The propensity scoring model had a c-statistic of 0.734, the Hosmer-Lemeshow chi-squared value was 7.036 (degrees of freedom = 8), and the non-significant p value of 0.533 indicated a good model fit. The propensity score matching created 31 matched pairs of patients, who had appropriately balanced characteristics. The FC group had a significantly higher in-hospital survival rate than the control group (log-rank p = 0.013). The FC group also used significantly higher amounts of red blood cells and fresh frozen plasma within 6 h after emergency department admission. However, the two groups had similar transfusion amounts between 6 and 24 h after emergency department admission. Fibrinogen administration resulted in a favourable survival rate among severe trauma patients. Fibrinogen may be useful for the early management of trauma-induced coagulopathy and may improve outcomes in this setting.
Fonte: doi: 10.1186/s13017-020-0291-9