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Coagulation management in trauma-associated coagulopathy: allogenic blood products versus coagulation factor concentrates in trauma care

Klages, Matthias; Zacharowski, Kai; Weber, Christian Friedrich

Current Opinion in Anaesthesiology: April 2016 - Volume 29 - Issue 2 - p 245–249
doi: 10.1097/ACO.0000000000000304
TRAUMA AND TRANSFUSION: Edited by Kai Zacharowski
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Purpose of review Coagulation management by transfusion of allogenic blood products and coagulation factors are competing concepts in current trauma care.

Recent findings Rapid and adequate therapy of trauma-associated coagulopathy is crucial to survival of severely injured patients. Standard coagulation tests such as prothrombin time and activated partial thromboplastin time are commonly used, but these tests are inappropriate for monitoring and guiding therapy in trauma patients. Coagulation factor-based treatment showed promising results, but randomized trials have not yet been performed. In addition, viscoelastic tests are needed to guide therapy, although there is in fact limited evidence for these in tests in trauma care. Regarding transfusion therapy with allogenic blood products, plasma transfusion has been associated with improved survival in trauma patients following massive transfusion. In contrast, patients not requiring massive transfusion seem to be at risk for suffering complications with increasing volumes of plasma transfused.

Summary The collective of trauma patients is heterogeneous. Despite the lack of evidence, there are strong arguments for individualized patient treatment with coagulation factors for some indications and to abstain from the use of fresh frozen plasma. In patients with severe trauma and major bleeding, plasma, platelets, and red blood cells should be considered to be administered at a ratio of 1 : 1 : 1.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany

Correspondence to Matthias Klages, MD, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. Tel: +49 0 69 6301 5998; fax: +49 0 69 6301 5881; e-mail: Matthias.Klages@kgu.de

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