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- W2315539687 abstract "Introduction: Coagulation factors concentrates (CFCs), mainly fibrinogen (Riastap®) and prothrombin complex concentrates (Prothromplex®) are becoming widespread used for treating life-threating hemorrhage in surgery. This retrospective, single center study was conducted to investigate the efficacy of CFCs at correcting coagulopathy and halting bleeding in massively transfused patients (≥ 4 packed red blood cells -RBC- transfused within ≤ 4 hour period). Methods: All patients who underwent major surgery over a 2-year period (2011-2013) and presented with severe perioperative bleeding were included. The efficacy of CFCs at improving acquired coagulopathy and decreasing blood transfusion was assessed by collecting the worst laboratory values and the number of transfused blood components units within two 6-hour periods, before and after CFCs administration (Table 1). Results: Eighty-three patients (median 58 years [IQR 45, 65] years, 59 % male, SOFA 7 [4,10]) were included. Thirty-six (43.4 %) underwent cardiac surgery, 31 (37.3 %) liver transplantation and 16 (19.3 %) other surgeries. Fifty-seven (68.7%) received Riastap® (2 g. [2, 4]), nine (10.8%) Prothromplex® (1,200 U. [600, 1800] and 17 (20.5%) both CFCs. Crude mortality was 50.6% (42 patients) with 62 % out of all deaths being considered as due to bleeding. Table 1. Laboratory values and blood transfusion within 6 hour before [1] and 6 hour after [2] of CFCs administration INR [1]=2.0 (1.2 - 2.8); [2]=1.6 (1.3 - 2.2) Fibrinogen (g/L) [1]=1.1 (0.8 - 2.3);[2]=1.8 (1.2 - 2.4) Hemoglobin (g/L) [1]= 83 (65, 99);[2]= 89 (75, 100) Platelets (x 109) [1]=85 (44, 164);[2]=81 (58, 113) RBC (units) [1]= 4 (3, 7);[2]=2 (1, 4); overall= 9 (6, 15) FFP (units) [1]= 2 (0, 3); [2]= 0 (0, 2); overall= 3 (1, 5) Platelets (pool) [1]= 1 (0, 2);[2]= 0 (0, 1); overall= 2 (1, 3) Bleeding (mL) [1]= 1200 (700, 2000);[2]= 500 (240, 1250); overall=1900 (500, 2700) All differences (6h. before vs. after, were significative); RBC: red blood cells; FFP: fresh frozen plasma Conclusions: In bleeding, over transfused patients with coagulopathy, CFCs administrations were associated with a decrease of transfusion requirements, although mortality rates were unacceptably high. Further investigation to ascertain whether an earlier, specific and sufficient (ROTEM-guided) administration of CFCs might improve patient outcome is warranted" @default.
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- W2315539687 date "2013-12-01" @default.
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- W2315539687 doi "https://doi.org/10.1097/01.ccm.0000440165.87867.0e" @default.
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