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Adjunct Factor Replacement

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Trauma Induced Coagulopathy

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Abstract

Development of early trauma-induced coagulopathy (TIC) is associated with increased morbidity and mortality and contributes to the “lethal triad” of coagulopathy, hypothermia, and acidosis which can have a mortality as high as 50%. This chapter focuses on the role of fibrinogen replacement and PCC for these patients. There is little disagreement that in the bleeding trauma patient, fibrinogen must be replete.

However, the source of fibrinogen concentrate or cryoprecipitate varies by nation and institution. Data supporting fibrinogen concentrate is promising, but there have been too few prospective direct comparisons with cryoprecipitate. Less uncertainty exists regarding the use of PCC therapy in patients with traumatic coagulopathy with PCC becoming the standard of care for reversal of warfarin-induced coagulopathy. PCC is also used for the reversal of novel oral anticoagulant (NOAC) medications; however, their effectiveness is less well understood.

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Authors and Affiliations

  1. Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jared R. Gallaher

  2. Oregon Health & Science University, Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Portland, OR, USA

    Christopher M. Freeman & Martin A. Schreiber

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Correspondence to Jared R. Gallaher .

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  1. Department of Surgery, University of Colorado, Aurora, CO, USA

    Hunter B. Moore

  2. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Matthew D. Neal

  3. Department of Surgery, University of Colorado Denver, Ernest E Moore Shock TraumaCenter at Denver Health, Denver, CO, USA

    Ernest E. Moore

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Gallaher, J.R., Freeman, C.M., Schreiber, M.A. (2021). Adjunct Factor Replacement. In: Moore, H.B., Neal, M.D., Moore, E.E. (eds) Trauma Induced Coagulopathy. Springer, Cham. https://doi.org/10.1007/978-3-030-53606-0_25

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