The use of coagulation factor concentrates for perioperative bleeding management – a global perspective

Grottke, Oliver; Callum, Jeannie; Cushing, Melissa M.; Haas, Thorsten

doi:10.1111/trf.15749

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…4,12 In central European countries, coagulation management is commonly based on coagulation factor concentrates (e.g., fibrinogen concentrate), administered according to point-of-care coagulation monitoring. 13 In other countries such as the United States, there is more reliance upon treatment with allogeneic blood products (e.g., cryoprecipitate and fresh frozen plasma), preferably using a fixed-ratio approach. There is also international recognition that tranexamic acid can reduce mortality by preventing fibrinolysis.…”

Section: Resultsmentioning

confidence: 99%

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Reversing Rivaroxaban Anticoagulation as Part of a Multimodal Hemostatic Intervention in a Polytrauma Animal Model

et al. 2021

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Background Life-threatening bleeding requires prompt reversal of the anticoagulant effects of factor Xa inhibitors. This study investigated the effectiveness of four-factor prothrombin complex concentrate in treating trauma-related hemorrhage with rivaroxaban-anticoagulation in a pig polytrauma model. This study also tested the hypothesis that the combined use of a low dose of prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate could improve its subtherapeutic effects. Methods Trauma (blunt liver injury and bilateral femur fractures) was induced in 48 anesthetized male pigs after 30 min of rivaroxaban infusion (1 mg/kg). Animals in the first part of the study received prothrombin complex concentrate (12.5, 25, and 50 U/kg). In the second part, animals were treated with 12.5 U/kg prothrombin complex concentrate plus tranexamic acid or plus tranexamic acid and fibrinogen concentrate. The primary endpoint was total blood loss postinjury. The secondary endpoints (panel of coagulation parameters and thrombin generation) were monitored for 240 min posttrauma or until death. Results The first part of the study showed that blood loss was significantly lower in the 25 U/kg prothrombin complex concentrate (1,541 ± 269 ml) and 50 U/kg prothrombin complex concentrate (1,464 ± 108 ml) compared with control (3,313 ± 634 ml), and 12.5 U/kg prothrombin complex concentrate (2,671 ± 334 ml, all P < 0.0001). In the second part of the study, blood loss was significantly less in the 12.5 U/kg prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate (1,836 ± 556 ml, P < 0.001) compared with 12.5 U/kg prothrombin complex concentrate plus tranexamic acid (2,910 ± 856 ml), and there were no early deaths in the 25 U/kg prothrombin complex concentrate, 50 U/kg prothrombin complex concentrate, and 12.5 U/kg prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate groups. Histopathologic analyses postmortem showed no adverse events. Conclusions Prothrombin complex concentrate effectively reduced blood loss, restored hemostasis, and balanced thrombin generation. A multimodal hemostatic approach using tranexamic acid plus fibrinogen concentrate enhanced the effect of low doses of prothrombin complex concentrate, potentially reducing the prothrombin complex concentrate doses required for effective bleeding control. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Resultsmentioning

confidence: 99%

“…, fibrinogen concentrate), administered according to point-of-care coagulation monitoring. 13 In other countries such as the United States, there is more reliance upon treatment with allogeneic blood products ( e.g. , cryoprecipitate and fresh frozen plasma), preferably using a fixed-ratio approach.…”

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confidence: 99%

Reversing Rivaroxaban Anticoagulation as Part of a Multimodal Hemostatic Intervention in a Polytrauma Animal Model

et al. 2021

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“…66,67 Recently, human-derived fibrinogen concentrates and commercially manufactured pathogen-reduced cryoprecipitate have emerged as alternatives to traditional cryoprecipitate transfusion. Fibrinogen concentrates can be stored dry and reconstituted at the bedside, 68 and pathogen-reduced cryoprecipitate can be kept thawed for up to 5 days. 69 These features may make them attractive for situations where rapid delivery of traditional cryoprecipitate is not possible.…”

Section: Cryoprecipitatementioning

confidence: 99%

What’s in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation

Hess

2023

Anesthesiology

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A general understanding of blood products and their modifications will help any physician make good decisions about transfusion. The separation of blood into products makes the fullest use of every donation: it maximizes the lifespan of each component, allows us to treat specific hematologic deficits, and offers the benefit of one donation to many patients. Every product is also modified in some way to prevent clotting, extend shelf life, improve efficacy, or reduce the risk of adverse events. Every one of these steps has been developed with patient benefit in mind, but they still have consequences that anesthesiologists have to be aware of. In some cases, these consequences have provoked complex responses: the development of Massive Transfusion Protocols and balanced "1:1:1" transfusions was essentially a scientific, clinical, and administrative effort to undo the inadvertent harms of separating whole blood into red cells, plasma, and platelets. With a limited blood supply and competing clinical requirements, understanding what you are actually transfusing is essential.In this narrative review, I will discuss the five basic blood products and five common modifications. Each product or modification is presented within a short clinical vignette; details are supplied in the figures and tables. I have also included a brief section on important transfusion reactions and their management. Finally, there is a list of additional resources for the interested reader. Blood ProductsOur blood supply in the United States comes from around 8 million donors who give between 1 and 20 times each year. 1 Although approximately 14 million products are collected every year, there are less than 2 weeks' supply of red cells and plasma in the U.S. inventory, and sometimes less than a day's supply of platelets. 2 Forty percent of the U.S. blood supply is collected by the American Red Cross (Washington, D.C.), with most of the rest collected by other independent institutions like Blood Bank of Hawaii (Honolulu, Hawaii) or OneBlood (St. Petersburg, Florida). 1,2 These blood centers are responsible for screening donors, collecting blood, separating them as necessary, labeling blood so it can be shipped in interstate commerce if the center is so licensed, and maintaining records (fig. 1). [3][4][5][6][7] Hospitals and clinics pay blood collectors for their products to cover the costs of materials, testing, and labor, with the specific price dependent on the unit and local contracts. There are also many for-profit blood centers that collect plasma and cells for the commercial preparations of albumin, immunoglobins, biologic therapies, and other reagents. Donors to commercial centers are usually paid to donate, but almost all blood collected for clinical transfusion in the United States comes from unpaid volunteers. 9 Low-titer Group O Whole BloodA 23-yr-old woman is hurt in a car crash. At the scene she has bilateral thigh deformities, tachycardia, hypotension, and altered consciousness. In the helicopter ride to the trauma center, she rece...

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Four-factor Prothrombin Complex Concentrate Use for Bleeding Management in Adult Trauma

Mora,

Maegele,

Grottke

et al. 2024

Anesthesiology

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The use of coagulation factor concentrates for perioperative bleeding management – a global perspective

Cited by 5 publications

References 20 publications

Reversing Rivaroxaban Anticoagulation as Part of a Multimodal Hemostatic Intervention in a Polytrauma Animal Model

Reversing Rivaroxaban Anticoagulation as Part of a Multimodal Hemostatic Intervention in a Polytrauma Animal Model

What’s in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation

Four-factor Prothrombin Complex Concentrate Use for Bleeding Management in Adult Trauma

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