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Is Fresh Frozen Plasma Still Necessary for Management of Acute Traumatic Coagulopathy?

  • Anesthesia for Trauma (TE Grissom, Section Editor)
  • Published:
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Abstract

Purpose of Review

Massive blood loss secondary to major trauma is a leading cause of death worldwide. In recent years, multiple different strategies have evolved to counteract this life-threatening condition. In this review, we will review our understanding of trauma-induced coagulopathy and summarize current clinical transfusion regimes utilized in military and civilian settings. We will review currently available blood products used to rectify the coherent disturbances of haemostasis by outlining the characteristics of the different products.

Recent Findings

Current evidence suggests that fresh frozen plasma and fibrinogen components play a fundamental role in trauma resuscitation with recent studies suggesting pre-hospital plasma and fibrinogen administration might also be beneficial in counteracting trauma-induced coagulopathy. Based on experience out of combat zones, whole blood transfusion might experience a renaissance in the future.

Summary

Multiple different plasma-based products are available to treat and prevent trauma-induced coagulation disturbances. As randomized controlled trials in trauma population are difficult to conduct, most of the evidence is currently based on relatively small studies. While the overarching result of our review suggests the early use of plasma and fibrinogen products in combination with packed red blood cells will prevent trauma-induced coagulopathy, large, multi-centre studies are warranted to evaluate the long-term effects on patients’ outcome.

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Abbreviations

aPC:

Activated protein C

aPTT:

Activated partial thromboplastin time

ARC:

American Red Cross

ATC:

Acute traumatic coagulopathy

FC:

Fibrinogen concentrate

FDA:

US Food and Drug Administration

FDP:

Freeze-dried human plasma

FFP:

Fresh frozen plasma

FLyP:

French lyophilised plasma

FVIII:

Coagulation factor VIII

FWB:

Fresh whole blood

ISS:

Injury severity score

LP:

Lyophilised plasma

LTOWB:

Low-titre group O whole blood

PCC:

Prothrombin complex concentrate

PRBC:

Packed red blood cell

PT:

Prothrombin time

PT:

prothrombin time

tPA:

Tissue plasminogen activator

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  1. Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK

    Giles R. Nordmann

  2. Department of Anesthesiology, Perioperative, and Pain Medicine Cardiovascular Institute, Outcomes Research™, Stanford University, Stanford, CA, 94304, USA

    Detlef Obal

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Nordmann, G.R., Obal, D. Is Fresh Frozen Plasma Still Necessary for Management of Acute Traumatic Coagulopathy?. Curr Anesthesiol Rep 10, 297–307 (2020). https://doi.org/10.1007/s40140-020-00397-3

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