Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients

Shaz, Beth H.; Dente, Christopher J.; Nicholas, Jeffrey M.; Macleod, Jana; Young, Andrew N.; Easley, Kirk A.; Ling, Qiang; Harris, Robert S.; Hillyer, Christopher D.

doi:10.1111/j.1537-2995.2009.02414.x

Cited by 216 publications

(193 citation statements)

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“…2,109 -111 The survival rate was significantly worse with a low FFP:RBC ratio (i.e., less than 1:2) relative to a high ratio (more than 1:1). 111,112 On the contrary, two other retrospective studies found no benefit of a high FFP:RBC ratio. 113,114 Differences in patient demographics, inclusion criteria, and transfusion protocols may have contributed to these conflicting findings.…”

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confidence: 78%

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

et al. 2010

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Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder. Reduced thrombin activation is partially compensated by lower inhibitory activities of antithrombin and other protease inhibitors, whereas plasma fibrinogen is rapidly decreased proportional to the extent of hemodilution. Adequate fibrinogen levels are essential in managing dilutional coagulopathy. After extensive hemodilution, fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased.Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies. Purified factor concentrates of plasma origin and from recombinant synthesis are increasingly used for a rapid restoration of targeted factors. Future clinical studies are necessary to establish the specific indication, dosing, and safety of novel hemostatic interventions.

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confidence: 78%

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

et al. 2010

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“…Deviation from the 1:1:1 target ratio was also observed in Shaz et al's study involving 132 civilian trauma patients; in that study, the MTP achieved a mean FFP:pRBC ratio of 0.5 and a mean PLT:pRBC ratio of 0.6. (22,23) Evidently, while an ideal transfusion ratio of 1:1:1 may be proposed in MTPs, it has been suggested that this target is not always achievable immediately. Notably, studies have shown that failure to achieve these ratios is associated with higher mortality.…”

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confidence: 99%

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Wijaya

Cheng

Chong

2016

smedj

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INTRODUCTIONMassive transfusion protocol (MTP) is increasingly used in civilian trauma cases to achieve better haemostatic resuscitation in patients requiring massive blood transfusions (MTs), with improved survival outcomes. However, in non-trauma patients, evidence for MTP is lacking. This study aims to assess the outcomes of a newly established MTP in a civilian setting, for both trauma and non-trauma patients, in an acute surgical care unit.METHODS A retrospective cohort analysis was performed on 46 patients for whom MTP was activated in Changi General Hospital, Singapore. The patients were categorised into trauma and non-trauma groups. Assessment of Blood Consumption (ABC) score was used to identify MTP trauma patients and analyse over-activation rates. RESULTSOnly 39.1% of all cases with MTP activation eventually received MTs; 39.8% of the MTs were for non-trauma patients. Mean fresh frozen plasma to packed red blood cells (pRBC) ratio achieved with MTP was 0.741, while mean platelet to pRBC ratio was 0.213. The 24-hour mortality rate for all patients who received an MT upon MTP activation was 33.3% (trauma vs. non-trauma group: 45.5% vs. 14.3%). The ABC scoring system used for trauma patients had a sensitivity and specificity of 81.8% and 41.2%, respectively. CONCLUSION MTP may be used for both trauma and non-trauma patients in acute care surgery. Scoring systems to predict the need for an MT, improved compliance to predefined transfusion ratios and regular reviews of the MTP are necessary to optimise MTPs and to improve the outcomes of patients receiving MTs.

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“…-İki puan %38 olasılıkla, 3 puan %45 olasılıkla, 4 puan ise %100 olasılıkla masif transfüzyon gereksinimi olacağına işaret eder. (10,11) . ES:TDP:Plt için 1:1:1 oranını önerenler de mevcuttur (12) .…”

Section: Masif Transfüzyona Gereksinimi Olan Hasta Nasıl Belirlenir?unclassified

Blood Transfusion and Massive Transfusion Protocols in War and Terror

Kılbaş¹,

Kaymak²

2017

Okmeydani Medical Journal

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Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients

Abstract: In the civilian setting, plasma, PLT, and cryoprecipitate products significantly increased 30-day survival in trauma patients. Future prospective randomized clinical trials are required to determine the optimal transfusion ratios.

Cited by 216 publications

References 18 publications

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Blood Transfusion and Massive Transfusion Protocols in War and Terror

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