Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays
Abstract Background Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational th...
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| Veröffentlicht in: | The Journal of surgical research 2015-04, Vol.194 (2), p.581-590 |
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| creator | Meyer, Martin A.S., BSc Ostrowski, Sisse R., MD, PhD, DMSc Sørensen, Anne Marie, MD, PhD Meyer, Anna Sina P., MD Holcomb, John B., MD Wade, Charles E., PhD Johansson, Pär I., MD, DMSc Stensballe, Jakob, MD, PhD |
| description | Abstract Background Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method. Materials and methods Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h. Results A total of 182 patients with an Injury Severity Score of 17 (9–26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both ρ = 0.64, P |
| doi_str_mv | 10.1016/j.jss.2014.11.021 |
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The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method. Materials and methods Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h. Results A total of 182 patients with an Injury Severity Score of 17 (9–26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both ρ = 0.64, P < 0.001), and FF MA and FIBTEM MCF correlated with each other (ρ = 0.71, P < 0.001). By logistic regression, the following cutoffs of fibrinogen levels were associated with increased odds of receiving a transfusion, red blood cell concentrates: Clauss <2.5 g/L, FF MA <14.9 mm, FIBTEM MCF <10 mm; fresh frozen plasma and platelets: Clauss <2.5 g/L, FF MA <16.9 mm, FIBTEM MCF <14 mm. Conclusions The viscoelastic hemostatic assays for determining fibrinogen levels, FIBTEM and FF, are both correlated with the Clauss fibrinogen level, and there are no differences in the strength of these correlations. In this study, specific fibrinogen levels at arrival to the emergency department were indicative, although not necessarily causal, of increased odds of receiving a transfusion.]]></description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2014.11.021</identifier><identifier>PMID: 25510310</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Bleeding ; Blood Transfusion ; Fibrinogen ; Fibrinogen - analysis ; FIBTEM ; Hemostasis ; Humans ; Middle Aged ; Odds Ratio ; Prospective Studies ; Regression Analysis ; Surgery ; Thrombelastography - methods ; Transfusion ; Trauma ; Wounds and Injuries - blood ; Wounds and Injuries - therapy</subject><ispartof>The Journal of surgical research, 2015-04, Vol.194 (2), p.581-590</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c544t-702c4f32a413a0d3c5a7a6457892d9a785c1dbd0b2602df2dade369b7c08cd163</citedby><cites>FETCH-LOGICAL-c544t-702c4f32a413a0d3c5a7a6457892d9a785c1dbd0b2602df2dade369b7c08cd163</cites><orcidid>0000-0002-6312-2457</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022480414010579$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25510310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meyer, Martin A.S., BSc</creatorcontrib><creatorcontrib>Ostrowski, Sisse R., MD, PhD, DMSc</creatorcontrib><creatorcontrib>Sørensen, Anne Marie, MD, PhD</creatorcontrib><creatorcontrib>Meyer, Anna Sina P., MD</creatorcontrib><creatorcontrib>Holcomb, John B., MD</creatorcontrib><creatorcontrib>Wade, Charles E., PhD</creatorcontrib><creatorcontrib>Johansson, Pär I., MD, DMSc</creatorcontrib><creatorcontrib>Stensballe, Jakob, MD, PhD</creatorcontrib><title>Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description><![CDATA[Abstract Background Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method. Materials and methods Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h. Results A total of 182 patients with an Injury Severity Score of 17 (9–26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both ρ = 0.64, P < 0.001), and FF MA and FIBTEM MCF correlated with each other (ρ = 0.71, P < 0.001). By logistic regression, the following cutoffs of fibrinogen levels were associated with increased odds of receiving a transfusion, red blood cell concentrates: Clauss <2.5 g/L, FF MA <14.9 mm, FIBTEM MCF <10 mm; fresh frozen plasma and platelets: Clauss <2.5 g/L, FF MA <16.9 mm, FIBTEM MCF <14 mm. Conclusions The viscoelastic hemostatic assays for determining fibrinogen levels, FIBTEM and FF, are both correlated with the Clauss fibrinogen level, and there are no differences in the strength of these correlations. In this study, specific fibrinogen levels at arrival to the emergency department were indicative, although not necessarily causal, of increased odds of receiving a transfusion.]]></description><subject>Adult</subject><subject>Bleeding</subject><subject>Blood Transfusion</subject><subject>Fibrinogen</subject><subject>Fibrinogen - analysis</subject><subject>FIBTEM</subject><subject>Hemostasis</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Prospective Studies</subject><subject>Regression Analysis</subject><subject>Surgery</subject><subject>Thrombelastography - methods</subject><subject>Transfusion</subject><subject>Trauma</subject><subject>Wounds and Injuries - blood</subject><subject>Wounds and Injuries - therapy</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUGL1TAQx4Mo7nP1A3iRHj3YOpOkzSuCIIurwoIH9RymSbqb2jbPpF3otzfP91Tw4GkY-P3_ML9h7DlChYDN66EaUqo4oKwQK-D4gO0Q2rrcN0o8ZDsAzku5B3nBnqQ0QN5bJR6zC17XCAJhx6Zr30U_h1s3F34ulkjrRK8Kmgt3T-NKiw9zEfpiuYth6txIaQm3kQ53W2ZsEcPyC6HxTIQTMrklbkX_t5tSoi09ZY96GpN7dp6X7Nv1-69XH8ubzx8-Xb27KU0t5VIq4Eb2gpNEQWCFqUlRI2u1b7ltSe1rg7az0PEGuO25JetE03bKwN5YbMQle3nqPcTwY3Vp0ZNPxo0jzS6sSWPTSGylUCqjeEJNDClF1-tD9BPFTSPoo2U96GxZHy1rRJ0t58yLc_3aTc7-SfzWmoE3J8DlI--9izoZ72bjrI_OLNoG_9_6t_-kzehnb2j87jaXhrDGLDxfoRPXoL8c33z8MkpAqFUrfgIuBaSQ</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Meyer, Martin A.S., BSc</creator><creator>Ostrowski, Sisse R., MD, PhD, DMSc</creator><creator>Sørensen, Anne Marie, MD, PhD</creator><creator>Meyer, Anna Sina P., MD</creator><creator>Holcomb, John B., MD</creator><creator>Wade, Charles E., PhD</creator><creator>Johansson, Pär I., MD, DMSc</creator><creator>Stensballe, Jakob, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6312-2457</orcidid></search><sort><creationdate>20150401</creationdate><title>Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays</title><author>Meyer, Martin A.S., BSc ; Ostrowski, Sisse R., MD, PhD, DMSc ; Sørensen, Anne Marie, MD, PhD ; Meyer, Anna Sina P., MD ; Holcomb, John B., MD ; Wade, Charles E., PhD ; Johansson, Pär I., MD, DMSc ; Stensballe, Jakob, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c544t-702c4f32a413a0d3c5a7a6457892d9a785c1dbd0b2602df2dade369b7c08cd163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Bleeding</topic><topic>Blood Transfusion</topic><topic>Fibrinogen</topic><topic>Fibrinogen - analysis</topic><topic>FIBTEM</topic><topic>Hemostasis</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Prospective Studies</topic><topic>Regression Analysis</topic><topic>Surgery</topic><topic>Thrombelastography - methods</topic><topic>Transfusion</topic><topic>Trauma</topic><topic>Wounds and Injuries - blood</topic><topic>Wounds and Injuries - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meyer, Martin A.S., BSc</creatorcontrib><creatorcontrib>Ostrowski, Sisse R., MD, PhD, DMSc</creatorcontrib><creatorcontrib>Sørensen, Anne Marie, MD, PhD</creatorcontrib><creatorcontrib>Meyer, Anna Sina P., MD</creatorcontrib><creatorcontrib>Holcomb, John B., MD</creatorcontrib><creatorcontrib>Wade, Charles E., PhD</creatorcontrib><creatorcontrib>Johansson, Pär I., MD, DMSc</creatorcontrib><creatorcontrib>Stensballe, Jakob, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meyer, Martin A.S., BSc</au><au>Ostrowski, Sisse R., MD, PhD, DMSc</au><au>Sørensen, Anne Marie, MD, PhD</au><au>Meyer, Anna Sina P., MD</au><au>Holcomb, John B., MD</au><au>Wade, Charles E., PhD</au><au>Johansson, Pär I., MD, DMSc</au><au>Stensballe, Jakob, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>194</volume><issue>2</issue><spage>581</spage><epage>590</epage><pages>581-590</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract><![CDATA[Abstract Background Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method. Materials and methods Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h. Results A total of 182 patients with an Injury Severity Score of 17 (9–26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both ρ = 0.64, P < 0.001), and FF MA and FIBTEM MCF correlated with each other (ρ = 0.71, P < 0.001). By logistic regression, the following cutoffs of fibrinogen levels were associated with increased odds of receiving a transfusion, red blood cell concentrates: Clauss <2.5 g/L, FF MA <14.9 mm, FIBTEM MCF <10 mm; fresh frozen plasma and platelets: Clauss <2.5 g/L, FF MA <16.9 mm, FIBTEM MCF <14 mm. Conclusions The viscoelastic hemostatic assays for determining fibrinogen levels, FIBTEM and FF, are both correlated with the Clauss fibrinogen level, and there are no differences in the strength of these correlations. In this study, specific fibrinogen levels at arrival to the emergency department were indicative, although not necessarily causal, of increased odds of receiving a transfusion.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25510310</pmid><doi>10.1016/j.jss.2014.11.021</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6312-2457</orcidid></addata></record> |
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| subjects | Adult Bleeding Blood Transfusion Fibrinogen Fibrinogen - analysis FIBTEM Hemostasis Humans Middle Aged Odds Ratio Prospective Studies Regression Analysis Surgery Thrombelastography - methods Transfusion Trauma Wounds and Injuries - blood Wounds and Injuries - therapy |
| title | Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays |
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