Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group.
<h4>Background</h4>Traumatic coagulopathy is thought to increase mortality and its treatment to reduce preventable deaths. However, there is still uncertainty in this field, and available literature results may have been overestimated.<h4>Methods</h4>We searched the MEDLINE d...
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Public Library of Science (PLoS)
2016-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0164090 |
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| author | Daniele Poole Andrea Cortegiani Arturo Chieregato Emanuele Russo Concetta Pellegrini Elvio De Blasio Francesca Mengoli Annalisa Volpi Silvia Grossi Lara Gianesello Vanni Orzalesi Francesca Fossi Osvaldo Chiara Carlo Coniglio Giovanni Gordini Trauma Update Working Group |
| author_facet | Daniele Poole Andrea Cortegiani Arturo Chieregato Emanuele Russo Concetta Pellegrini Elvio De Blasio Francesca Mengoli Annalisa Volpi Silvia Grossi Lara Gianesello Vanni Orzalesi Francesca Fossi Osvaldo Chiara Carlo Coniglio Giovanni Gordini Trauma Update Working Group |
| author_sort | Daniele Poole |
| collection | DOAJ |
| description | <h4>Background</h4>Traumatic coagulopathy is thought to increase mortality and its treatment to reduce preventable deaths. However, there is still uncertainty in this field, and available literature results may have been overestimated.<h4>Methods</h4>We searched the MEDLINE database using the PubMed platform. We formulated four queries investigating the prognostic weight of traumatic coagulopathy defined according to conventional laboratory testing, and the effectiveness in reducing mortality of three different treatments aimed at contrasting coagulopathy (high fresh frozen plasma/packed red blood cells ratios, fibrinogen, and tranexamic acid administration). Randomized controlled trials were selected along with observational studies that used a multivariable approach to adjust for confounding. Strict criteria were adopted for quality assessment based on a two-step approach. First, we rated quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Then, this rating was downgraded if other three criteria were not met: high reporting quality according to shared standards, absence of internal methodological and statistical issues not detailed by the GRADE system, and absence of external validity issues.<h4>Results</h4>With few exceptions, the GRADE rating, reporting and methodological quality of observational studies was "very low", with frequent external validity issues. The only two randomized trials retrieved were, instead, of high quality. Only weak evidence was found for a relation between coagulopathy and mortality. Very weak evidence was found supporting the use of fibrinogen administration to reduce mortality in trauma. On the other hand, we found high evidence that the use of 1:1 vs. 1:2 high fresh frozen plasma/packed red blood cells ratios failed to obtain a 12% mortality reduction. This does not exclude lower mortality rates, which have not been investigated. The use of tranexamic acid in trauma was supported by "high" quality evidence according to the GRADE classification but was downgraded to "moderate" for external validity issues.<h4>Conclusions</h4>Tranexamic acid is effective in reducing mortality in trauma. The other transfusion practices we investigated have been inadequately studied in the literature, as well as the independent association between mortality and coagulopathy measured with traditional laboratory testing. Overall, in this field of research literature quality is poor. |
| format | Article |
| id | doaj-art-384b62dc0b2e40a9ac6a9fd1ae7d3a9f |
| institution | Matheson Library |
| issn | 1932-6203 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-384b62dc0b2e40a9ac6a9fd1ae7d3a9f2025-06-30T05:32:15ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-011110e016409010.1371/journal.pone.0164090Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group.Daniele PooleAndrea CortegianiArturo ChieregatoEmanuele RussoConcetta PellegriniElvio De BlasioFrancesca MengoliAnnalisa VolpiSilvia GrossiLara GianeselloVanni OrzalesiFrancesca FossiOsvaldo ChiaraCarlo ConiglioGiovanni GordiniTrauma Update Working Group<h4>Background</h4>Traumatic coagulopathy is thought to increase mortality and its treatment to reduce preventable deaths. However, there is still uncertainty in this field, and available literature results may have been overestimated.<h4>Methods</h4>We searched the MEDLINE database using the PubMed platform. We formulated four queries investigating the prognostic weight of traumatic coagulopathy defined according to conventional laboratory testing, and the effectiveness in reducing mortality of three different treatments aimed at contrasting coagulopathy (high fresh frozen plasma/packed red blood cells ratios, fibrinogen, and tranexamic acid administration). Randomized controlled trials were selected along with observational studies that used a multivariable approach to adjust for confounding. Strict criteria were adopted for quality assessment based on a two-step approach. First, we rated quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Then, this rating was downgraded if other three criteria were not met: high reporting quality according to shared standards, absence of internal methodological and statistical issues not detailed by the GRADE system, and absence of external validity issues.<h4>Results</h4>With few exceptions, the GRADE rating, reporting and methodological quality of observational studies was "very low", with frequent external validity issues. The only two randomized trials retrieved were, instead, of high quality. Only weak evidence was found for a relation between coagulopathy and mortality. Very weak evidence was found supporting the use of fibrinogen administration to reduce mortality in trauma. On the other hand, we found high evidence that the use of 1:1 vs. 1:2 high fresh frozen plasma/packed red blood cells ratios failed to obtain a 12% mortality reduction. This does not exclude lower mortality rates, which have not been investigated. The use of tranexamic acid in trauma was supported by "high" quality evidence according to the GRADE classification but was downgraded to "moderate" for external validity issues.<h4>Conclusions</h4>Tranexamic acid is effective in reducing mortality in trauma. The other transfusion practices we investigated have been inadequately studied in the literature, as well as the independent association between mortality and coagulopathy measured with traditional laboratory testing. Overall, in this field of research literature quality is poor.https://doi.org/10.1371/journal.pone.0164090 |
| spellingShingle | Daniele Poole Andrea Cortegiani Arturo Chieregato Emanuele Russo Concetta Pellegrini Elvio De Blasio Francesca Mengoli Annalisa Volpi Silvia Grossi Lara Gianesello Vanni Orzalesi Francesca Fossi Osvaldo Chiara Carlo Coniglio Giovanni Gordini Trauma Update Working Group Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group. PLoS ONE |
| title | Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group. |
| title_full | Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group. |
| title_fullStr | Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group. |
| title_full_unstemmed | Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group. |
| title_short | Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group. |
| title_sort | blood component therapy and coagulopathy in trauma a systematic review of the literature from the trauma update group |
| url | https://doi.org/10.1371/journal.pone.0164090 |
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