Impact of fibrinogen concentrate alone or with prothrombin complex concentrate (+/− fresh frozen plasma) on plasma fibrinogen level and fibrin-based clot strength (FIBTEM) in major trauma: a retrospective study

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

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How does prothrombin complex concentrate compare with fresh frozen plasma for the reversal of vitamin K antagonist treatment?

Cochrane Clinical Answers ◽

10.1002/cca.1155 ◽

2016 ◽

Author(s):

Anna Wrzosek

Keyword(s):

Vitamin K ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Vitamin K Antagonist ◽

Fresh Frozen ◽

Frozen Plasma

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An Exploratory Cohort Study Comparing Prothrombin Complex Concentrate and Fresh Frozen Plasma for the Treatment of Coagulopathy After Complex Cardiac Surgery

Anesthesia & Analgesia ◽

10.1213/ane.0000000000000689 ◽

2015 ◽

Vol 121 (1) ◽

pp. 26-33 ◽

Cited By ~ 47

Author(s):

Erik Ortmann ◽

Martin W. Besser ◽

Linda D. Sharples ◽

Caroline Gerrard ◽

Marius Berman ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Frozen Plasma

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Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.10.025 ◽

2019 ◽

Vol 28 (12) ◽

pp. 1881-1887 ◽

Cited By ~ 6

Author(s):

Fausto Biancari ◽

Vito G. Ruggieri ◽

Andrea Perrotti ◽

Riccardo Gherli ◽

Till Demal ◽

...

Keyword(s):

Comparative Analysis ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Coronary Surgery ◽

Fresh Frozen ◽

Frozen Plasma

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Fibrinogen concentrate and cryoprecipitate but not fresh frozen plasma correct low fibrinogen concentrations following in vitro haemodilution

Thrombosis Research ◽

10.1016/j.thromres.2013.02.009 ◽

2013 ◽

Vol 131 (5) ◽

pp. e210-e213 ◽

Cited By ~ 14

Author(s):

Christian Fenger-Eriksen ◽

Kirsten Christiansen ◽

John Laurie ◽

Benny Sørensen ◽

Catherine Rea

Keyword(s):

Fresh Frozen Plasma ◽

Fibrinogen Concentrate ◽

Fresh Frozen ◽

Frozen Plasma

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Anticoagulants and antithrombotics in critical illness

10.1093/med/9780199600830.003.0051 ◽

2016 ◽

Author(s):

Vickie McDonald ◽

Marie Scully

Keyword(s):

Platelet Count ◽

Critical Illness ◽

Prothrombin Complex Concentrate ◽

Oral Anticoagulants ◽

Fresh Frozen Plasma ◽

Heparin Therapy ◽

Heparin Induced Thrombocytopenia ◽

Routine Monitoring ◽

Fresh Frozen ◽

Frozen Plasma

Coagulation is best thought of using the cell-based model of coagulation. Patients commenced on heparin therapy should have their platelet count monitored early because of the risk of heparin-induced thrombocytopenia, which can occur on any type or dose of heparin. Emergency reversal of warfarin should be with prothrombin complex concentrate (containing factors II, VII, IX, and X) and not fresh frozen plasma. New oral anticoagulants have the advantage of predictable pharmacokinetics and do not require routine monitoring, but optimal reversal strategies for these agents are not clear. Thrombolytic agents lead to variable degrees of systemic lysis, which may cause haemorrhage, including intracerebral haemorrhage

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Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613443 ◽

2003 ◽

Vol 89 (02) ◽

pp. 278-283 ◽

Cited By ~ 95

Author(s):

Kazuo Minematsu ◽

Hiroaki Naritomi ◽

Toshiyuki Sakata ◽

Takenori Yamaguchi ◽

Masahiro Yasaka

Keyword(s):

Logistic Regression Model ◽

Prothrombin Complex Concentrate ◽

Warfarin Therapy ◽

International Normalized Ratio ◽

Fresh Frozen Plasma ◽

Predisposing Factors ◽

Predisposing Factor ◽

Fresh Frozen ◽

Cerebral Hematoma ◽

Frozen Plasma

SummaryTo elucidate predisposing factors for enlargement of intra-cerebral hematoma (ICH) during warfarin therapy, we reviewed 47 patients on warfarin who developed acute ICH and determined relationships among ICH enlargement, INR reversal and clinical data. Among 36 patients treated to counteract the effects of warfarin within 24 h of onset, ICH increased in 10 patients (enlarged group), but remained unchanged in the remaining 26 (unchanged group), while ICH remained unchanged in another 11 patients in whom the effect of warfarin was reversed after 24 h. The international normalized ratio (INR) was counteracted immediately in 11 patients treated with prothrombin complex concentrate (PCC) but gradually in the other 36 treated by reducing the dose of warfarin, or by administering vitamin K or fresh frozen plasma. Multivariate analysis with a logistic regression model showed an INR value <2.0 at admission or for 24 h after immediate INR correction with PCC prevented ICH enlargement (OR 0.069, 95%CI 0.006-0.789, p = 0.031). An INR value of >2.0 within 24 h of ICH seems an important predisposing factor for ICH enlargement.

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