Efficacy of fibrinogen and prothrombin complex concentrate used to reverse dilutional coagulopathy—a porcine model

Abstract

During haemodilution, substitution of fibrinogen and PCC causes an enhancement of coagulation and final clot strength. This reversal of dilutional coagulopathy may reduce blood loss and mortality when large amounts of colloids are needed to maintain normovolaemia during huge blood losses.

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

“…10,37,38,42 Each unit of FFP in addition to coagulation factors contains 0.5 g of fibrinogen. 37 Recent studies suggest that fibrinogen administration is essential for achieving hemostasis in patients with significant traumatic injuries [43][44][45][46][47][48] and very likely contributes to the improved outcomes that have been associated with increased transfusion of plasma. 7,49,50 However, the use of plasma as a volume expander is controversial though this practice has been relatively abandoned since the 1940s.…”

Monitoring Recombinant Factor VIIa Treatment: Efficacy Depends on High Levels of Fibrinogen in a Model of Severe Dilutional Coagulopathy

“…Furthermore, combining fibrinogen and prothrombin complex concentrate (factor II, VII, IX, X) administration has recently been shown to further improve dilutional coagulopathy resulting in normalization of coagulation parameters measured. 27 rFVIIa treatment is currently approved for patients with congenital or acquired hemophilia with antibodies to Factor VIII or IX (United States and Europe), factor VII deficiency and Glanzmanns thrombasthenia (Europe). However, VIIa is increasingly used in off-label indications to control severe bleeding.…”

Reversal of vitamin K antagonists prior to urgent surgery

“…55 In a similar animal model, PCC, but not FP, fully reversed the effects of a dilutional coagulopathy on PT and reduced blood loss resulting from both bone and soft tissue injury. 56 Prothrombin complex concentrate has been used in cardiac and non-cardiac surgical patients to treat microvascular bleeding that does not respond to factor replacement therapy with FP and platelets.…”