Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany.
Injury. 2011 Jul;42(7):697-701. doi: 10.1016/j.injury.2010.12.015. Epub 2011 Mar 9.
Clinical observations together with recent research highlighted the role of coagulopathy in acute trauma care and early aggressive treatment has been shown to reduce mortality.
Datasets from severely injured and bleeding patients with established coagulopathy upon emergency room (ER) arrival from two retrospective trauma databases, (i) TR-DGU (Germany) and (ii) Innsbruck Trauma Databank/ITB (Austria), that had received two different strategies of coagulopathy management during initial resuscitation, (i) fresh frozen plasma (FFP) without coagulation factor concentrates, and (ii) coagulation factor concentrates (fibrinogen and/or prothrombin complex concentrates) without FFP, were compared for morbidity, mortality and transfusion requirements using a matched-pair analysis approach.
There were no major differences in basic characteristics and physiological variables upon ER admission between the two cohorts that were matched. ITB patients had received substantially less packed red blood cell (pRBC) concentrates within the first 6h after admission (median 1.0 (IQR(25-75) 0-3) vs 7.5 (IQR(25-75) 4-12) units; p<0.005) and the first 24h as compared to TR-DGU patients (median 3 (IQR(25-75) 0-5) vs 12.5 (8-20) units; p<0.005). Overall mortality was comparable between both groups whilst the frequency for multi organ failure was significantly lower within the group that had received coagulation factor concentrates exclusively and no FFP during initial resuscitation (n=3 vs n=15; p=0.015). This translated into trends towards reduced days on ventilator whilst on ICU and shorter overall in-hospital length of stays (LOS).
Although there was no difference in overall mortality between both groups, significant differences with regard to morbidity and need for allogenic transfusion provide a signal supporting the management of acute post-traumatic coagulopathy with coagulation factor concentrates rather than with traditional FFP transfusions. Prospective and randomised clinical trials with sufficient patient numbers based upon this strategy are advocated.
临床观察和最近的研究强调了出凝血障碍在急性创伤治疗中的作用，早期积极治疗已被证明可降低死亡率。
从两个回顾性创伤数据库（德国的 TR-DGU 和奥地利的因斯布鲁克创伤数据库/ITB）中获取到达急诊室（ER）时已出现凝血障碍的严重创伤和出血患者的数据。在初始复苏期间，这两个数据库接受了两种不同的出凝血障碍管理策略，（i）未使用凝血因子浓缩物的新鲜冷冻血浆（FFP），和（ii）未使用 FFP 的纤维蛋白原和/或凝血酶原复合物浓缩物），通过配对分析方法比较发病率、死亡率和输血需求。
在匹配的两组患者中，ER 入院时的基本特征和生理变量没有明显差异。ITB 患者在入院后 6 小时内接受的浓缩红细胞（pRBC）浓缩物明显较少（中位数 1.0（IQR（25-75）0-3）比 7.5（IQR（25-75）4-12）单位；p<0.005），并且在 24 小时内也比 TR-DGU 患者少（中位数 3（IQR（25-75）0-5）比 12.5（8-20）单位；p<0.005）。两组总体死亡率相当，而在初始复苏期间仅接受凝血因子浓缩物而不接受 FFP 的组中，多器官衰竭的发生率显著降低（n=3 比 n=15；p=0.015）。这转化为 ICU 呼吸机使用天数减少和总住院时间缩短的趋势。
尽管两组之间的总体死亡率没有差异，但在发病率和异体输血需求方面存在显著差异，这为支持使用凝血因子浓缩物而不是传统 FFP 输血治疗急性创伤后出凝血障碍提供了信号。提倡在此策略基础上进行基于足够患者数量的前瞻性和随机临床试验。
