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- Title
Administration of fibrinogen concentrate for refractory bleeding in massively transfused, non-trauma patients with coagulopathy: a retrospective study with comparator group.
- Authors
Leal-Noval, Santiago R.; Casado, Manuel; Arellano-Orden, Victoria; Dusseck, Reginald; Bautista-Paloma, Javier; Muñoz, Manuel; Naranjo-Izorieta, José; Puppo Moreno, Antonio; Cayuela, Aurelio
- Abstract
Background This retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy. Methods Over a 3-years period, all patients for whom a massive transfusion protocol was activated and had received ≥4 units of allogeneic blood components within a ≤4 h period, were included. Patients were classified according to whether they received FBNc or achieved an optimal fibrinogen level of ≥2 g/L within 24 h after FBNc administration. Results Seventy-one patients received 2 [2,4] g of FBNc (FBNc group) and 72 did not (comparator group). FBNc was administered after transfusing 5 [5,9] blood component units, 3 [2,6] hours after massive transfusion protocol activation. Linear regression analysis showed that SOFA (AOR 0.75 [95%CI:0.08-1.43]) and admission fibrinogen level (AOR -2.7 [95%CI:-4.68 - - 0.78]), but not FBNc administration, were independently associated with total transfused units. There was a significant inverse relation between both admission and target fibrinogen levels, and total transfused components. Logistic regression showed a direct relationship between admission fibrinogen level and achieving a target level ≥2 g/L (AOR 3.29 [95%CI;1.95-5.56]). No thromboembolic events associated with FBNc were observed. Conclusions In massively transfused, non-trauma patients with coagulopathy and refractory bleeding, late administration of low FBNc dosage was not associated with decreased blood transfusion or increased post-infusion fibrinogen level. Given that both fibrinogen upon admission and target fibrinogen levels were associated with decreased blood transfusion, earlier administration and higher doses of FBNc could be needed.
- Subjects
SPAIN; FIBRINOGEN; ACADEMIC medical centers; ANALYSIS of variance; BLOOD transfusion; CONFIDENCE intervals; HEMORRHAGE; PROBABILITY theory; STATISTICS; LOGISTIC regression analysis; DATA analysis software; MANN Whitney U Test; THERAPEUTICS
- Publication
BMC Anesthesiology, 2014, Vol 14, Issue 1, p1
- ISSN
1471-2253
- Publication type
Article
- DOI
10.1186/1471-2253-14-109