Fibrinogen in traumatic haemorrhage

Authors: Winearls, J; Reade, M; McQuilten, Z; Curry, N.

Affiliations: Gold Coast University Hospital, Gold Coast Senior Lecturer, School of Medicine, University of Queensland, Brisbane; Griffith University, Gold Coast Consultant Intensivist St Andrews War Memorial, Joint Health Command, Australian Defence Force; Faculty of Medicine, University of Queensland, Royal Brisbane and Women’s Hospital, Transfusion Research Unit, Monash University, Monash Health, Melbourne, Australia, Department of Haematology Head of Department, Oxford Haemophilia & Thrombosis Centre, Oxford University Hospitals NHS Trust, Oxford, UK.

Publication: Current opinion in anaesthesiology ; 2021

Abstract: PURPOSE OF REVIEW: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy (TIC) have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage. RECENT FINDINGS: Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, there is little evidence to support or refute the effects of cryoprecipitate or fibrinogen concentrate for fibrinogen replacement. SUMMARY: The important role fibrinogen plays in haemostasis and effective clot formation is clear. A number of pilot trials have investigated different strategies for fibrinogen replacement in severe trauma. These trials have formed the basis of several large-scale phase III trials, which, cumulatively will provide a firm evidence base to harmonise worldwide clinical management of severely injured trauma patients with major haemorrhage.