Nathwani Rajen, Proumen Adrian, Blaine Kevin P
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
State University of New York (SUNY) Upstate University Hospital, Syracuse, New York.
Curr Opin Anaesthesiol. 2023 Jun 1;36(3):382-387. doi: 10.1097/ACO.0000000000001265. Epub 2023 Mar 6.
Fibrin polymerization is essential for stable clot formation in trauma, and hypofibrinogenemia reduces hemostasis in trauma. This review considers fibrinogen biology, the changes that fibrinogen undergoes after major trauma, and current evidence for lab testing and treatment.
Fibrinogen is a polypeptide that is converted to fibrin by the action of thrombin. During trauma, fibrinogen levels are consumed and reduce within the first few hours because of consumption, dilution, and fibrinolysis. Fibrinogen levels usually rebound within 48 hours of injury and can contribute to thrombotic events. The Clauss fibrinogen assay is the gold standard test for fibrinogen levels, although viscoelastic hemostatic assays are often used when a lab delay is anticipated. An evidence-based threshold for fibrinogen replacement is not well established in the literature, but expert opinion recommends maintaining a level above 150 mg/dl.
Hypofibrinogenemia is an important cause of nonanatomic bleeding in trauma. Despite multiple pathologic causes, the cornerstone of treatment remains fibrinogen replacement with cryoprecipitate or fibrinogen concentrates.
纤维蛋白聚合对于创伤中稳定血凝块的形成至关重要，而低纤维蛋白原血症会降低创伤中的止血能力。本综述探讨纤维蛋白原生物学、重大创伤后纤维蛋白原所经历的变化以及当前实验室检测和治疗的证据。
纤维蛋白原是一种多肽，在凝血酶的作用下转化为纤维蛋白。在创伤期间，由于消耗、稀释和纤维蛋白溶解，纤维蛋白原水平在最初几个小时内被消耗并降低。纤维蛋白原水平通常在受伤后48小时内反弹，并可能导致血栓形成事件。Clauss纤维蛋白原测定是纤维蛋白原水平的金标准检测方法，尽管在预计实验室检测延迟时通常使用粘弹性止血检测。纤维蛋白原替代的循证阈值在文献中尚未明确确立，但专家意见建议维持水平高于150mg/dl。
低纤维蛋白原血症是创伤中非解剖学出血的重要原因。尽管有多种病理原因，但治疗的基石仍然是用冷沉淀或纤维蛋白原浓缩物替代纤维蛋白原。
