Transfusion in trauma thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy 英文参考文献.docVIP

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Transfusion in trauma thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy 英文参考文献.doc

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Transfusion in trauma thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy 英文参考文献

Sch?chletal.CriticalCare2011,15:R83 /content/15/2/R83 RESEARCH OpenAccess Transfusionintrauma:thromboelastometry-guided coagulationfactorconcentrate-basedtherapy versusstandardfreshfrozenplasma-basedtherapy HerbertSch?chl1,2,UlrikeNienaber3,MarcMaegele4,GeraldHochleitner5,FlorianPrimavesi2,BeatriceSteitz6, ChristianArndt7,AlexanderHanke8,WolfgangVoelckel2andCristinaSolomon6* Abstract Introduction:Thromboelastometry(TEM)-guidedhaemostatictherapywithfibrinogenconcentrateand prothrombincomplexconcentrate(PCC)intraumapatientsmayreducetheneedfortransfusionofredbloodcells (RBC)orplateletconcentrate,comparedwithfreshfrozenplasma(FFP)-basedhaemostatictherapy. Methods:ThisretrospectiveanalysiscomparedpatientsfromtheSalzburgTraumaCentre(Salzburg,Austria) treatedwithfibrinogenconcentrateand/orPCC,butnoFFP(fibrinogen-PCCgroup,n=80),andpatientsfromthe TraumaRegisterDGUreceiving≥2unitsofFFP,butnofibrinogenconcentrate/PCC(FFPgroup,n=601).Inclusion criteriawere:age18-70years,basedeficitatadmission≥2mmol/L,injuryseverityscore(ISS)≥16,abbreviated injuryscaleforthoraxand/orabdomenand/orextremity≥3,andforhead/neck5. Results:Forhaemostatictherapyintheemergencyroomandduringsurgery,theFFPgroup(ISS35.5±10.5) receivedamedianof6unitsofFFP(range:2,51),whilethefibrinogen-PCCgroup(ISS35.2±12.5)received mediansof6goffibrinogenconcentrate(range:0,15)and1200UofPCC(range:0,6600).RBCtransfusionwas avoidedin29%ofpatientsinthefibrinogen-PCCgroupcomparedwithonly3%intheFFPgroup(P 0.001). Transfusionofplateletconcentratewasavoidedin91%ofpatientsinthefibrinogen-PCCgroup,comparedwith 56%intheFFPgroup(P0.001).Mortalitywascomparablebetweengroups:7.5%inthefibrinogen-PCCgroup and10.0%intheFFPgroup(P=0.69). Conclusions:TEM-guidedhaemostatictherapywithfibrinogenconcentrateandPCCreducedtheexposureof traumapatientstoallogeneicbloodproducts. Introduction thatthetimetointervention mayalsobeanimportant Inpatientswithseveretrauma,coagulopathyrepresents determinantofpatientoutcom