High-dose fibrinogen concentrate for haemostatic therapy of a major trauma patient with recent clopidogrel and aspirin intake

Scandinavian Journal of Clinical and Laboratory Investigation
Herbert SchöchlC Solomon

Abstract

We report on a severely injured trauma patient who suffered a high velocity motorcycle accident. The patient was receiving dual antiplatelet therapy with aspirin and clopidogrel. Thromboelastometry (ROTEM(®)) on admission revealed low maximum clot firmness (MCF) in the FIBTEM assay, strongly indicating impaired fibrin polymerization. Inhibition of platelet activity also was confirmed. Massive intra-abdominal bleeding caused by a liver rupture required immediate laparotomy. Haemostasis during emergency surgery was achieved through topical surgical measures and intravenous fibrinogen concentrate administration (three doses of 4 g), guided by ROTEM test results only. As platelet count decreased to 28 × 10(9) L(-1), 6 h after admission to the intensive care unit, the patient received two units of platelet concentrate. No further haemostatic therapy was necessary during the next 48 h. This case shows the potential effectiveness of fibrinogen concentrate in improving haemostasis in trauma patients receiving antiplatelet therapy.

Associated Clinical Trials

References

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Citations

Oct 18, 2011·Critical Care : the Official Journal of the Critical Care Forum·Sibylle Kozek-LangeneckerDonat R Spahn
Jan 25, 2014·The Journal of Trauma and Acute Care Surgery·Lucy Z KornblithMitchell Jay Cohen
Feb 11, 2014·Journal of Critical Care·C AubronD J Cooper
Aug 9, 2013·Journal of Cardiothoracic and Vascular Anesthesia·Herbert SchöchlChristoph J Schlimp
Jun 10, 2011·Thrombosis and Haemostasis·Cristina SolomonHerbert Schöchl
Jul 17, 2013·Journal of Thrombosis and Haemostasis : JTH·R A Kadir, J Davies
May 4, 2011·Vox Sanguinis·M A S MeyerP I Johansson
Jan 12, 2012·Scandinavian Journal of Clinical and Laboratory Investigation·Cristina SolomonNiels Rahe-Meyer
Apr 14, 2016·Critical Care : the Official Journal of the Critical Care Forum·Rolf RossaintDonat R Spahn
Nov 2, 2016·British Journal of Anaesthesia·D Bolliger, K A Tanaka
Nov 27, 2014·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Manuela CarvalhoManuel Campos
Aug 9, 2011·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Jacqueline MauchThorsten Haas
May 10, 2013·European Journal of Anaesthesiology·Sibylle A Kozek-LangeneckerPiet Wyffels
Nov 25, 2011·Current Opinion in Anaesthesiology·Aryeh Shander, Mazyar Javidroozi
Sep 10, 2015·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Enrico BernardiUNKNOWN Advisory Board of the Italian Society of Emergency Medicine (SIMEU)
Apr 28, 2016·The Journal of Trauma and Acute Care Surgery·Bijan Shams KheirabadiMichael A Dubick
Aug 10, 2012·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Alberto GrassettoCarlo Maggiolo
May 24, 2015·The Journal of Trauma and Acute Care Surgery·Marc MaegeleDietmar Fries
Sep 29, 2012·The Journal of Trauma and Acute Care Surgery·Victor A FerrarisBrannon Hyde

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