The role of fibrinogen in trauma-induced coagulopathy^[*]

Summary

Fibrinogen plays an essential role in clot formation and stability. Importantly it seems to be the most vulnerable coagulation factor, reaching critical levels earlier than the others during the course of severe injury. A variety of causes of fibrinogen depletion in major trauma have been identified, such as blood loss, dilution, consumption, hyperfibrinolysis, hypothermia and acidosis. Low concentrations of fibrinogen are associated with an increased risk of diffuse microvascular bleeding. Therefore, repeated measurements of plasma fibrinogen concentration are strongly recommended in trauma patients with major bleeding. Recent guidelines recommend maintaining plasma fibrinogen concentration at 1.5–2 g/l in coagulopathic patients. It has been shown that early fibrinogen substitution is associated with improved outcome.

Zusammenfassung

Fibrinogen spielt eine wichtige Rolle in der Hämostase und bei der Bildung eines stabilen Blutgerinnsels. Von allen Gerinnungsfaktoren fällt Fibrinogen bei schweren Verletzungen am frühesten unter einen kritischen Schwellenwert. Die Hauptgründe dafür sind Blutverlust, Dilution, Verbrauch, Hyperfibrinolyse, Hypothermie und Azidose. Niedrige Fibrinogenspiegel gehen mit einem erhöhten Risiko von mikrovaskulären Blutungen einher. Daher wird in Patienten mit schweren Blutungen die wiederholte Messung des Fibrinogens empfohlen. Aktuelle Leitlinien empfehlen einen Plasmafibrinogenwert von 1,5–2 g/l in koagulopathischen Traumapatienten. Es konnte gezeigt werden, dass die frühe Fibrinogensubstitution, vorzugsweise mit Fibrinogenkonzentrat, mit einem verbesserten Outcome einhergeht.

Keywords

Fibrinogen - trauma - coagulopathy

Schlüsselwörter

Fibrinogen - Trauma - Gerinnungsstörung

^* Attributed to Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre Vienna (Head: Prof. Dr. Heinz Redl)

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