Letter

Which is the most effective strategy: early detection of coagulopathy with thromboelastometry or use of hemostatic factors or both?

Jean-Stephane David^1*, Virginie Marchal¹, Albrice Levrat¹ and Kenji Inaba²

• * Corresponding author: Jean-Stephane David jean-stephane.david@chu-lyon.fr

Author Affiliations

¹ Department of Anesthesiology and Critical Care, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon-Sud Hospital and University Lyon 1, Department of Anesthesiology and Critical Care, 165 Chemin du Grand Revoyet, F-69495 Pierre Benite, France

² Division of Trauma Surgery and Surgical Critical Care, University of Southerm California, USC LAC Madical Center, 1200 North State Street, Inpatient Tower (C)-Room C5L100, Los Angeles, CA 90033, USA

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Critical Care 2011, 15:433 doi:10.1186/cc10224

See related research by Schöchl et al., http://ccforum.com/content/15/2/R83

Published: 13 June 2011

First paragraph (this article has no abstract)

In an article in the previous issue of Critical Care, Schöchl and colleagues suggested that, in trauma patients, a hemostatic strategy combining the use of fibrinogen concentrates or prothrombin complex concentrates (PCCs) (or both) guided by thromboelastometry resulted in a reduction of exposure to allogeneic blood products when compared with a strategy using fresh frozen plasma (FFP) guided by standard coagulation assays [1]. The primary concern with this analysis is the comparison of a series of patients treated at a single center with a highly protocolized approach to transfusion against a registry-based cohort of patients from multiple centers with no standardized protocol. Also, several very specific biases introduced into the analysis are of concern. First, the time required to obtain a hemostatic result varied greatly between groups, ranging from less than 15 minutes with the rotation thrombelastography (ROTEM) to usually more than 45 to 60 minutes in the standard group [2]. The timing of coagulation component replacement must be factored into this analysis. The second bias centers around the concentration of fibrinogen delivered: 3 g of fibrinogen (median of 6 units of FFP) in the FFP group versus a median of 6 g in the fibrinogen-PCC group. Previous reports have demonstrated a close relationship between blood loss and fibrinogen level [3,4].