High-dose fibrinogen concentrate for haemostatic therapy of a major trauma patient with recent clopidogrel and aspirin intake

Abstract

Introduction. We report on a severely injured trauma patient who suffered a high velocity motorcycle accident. The patient was receiving dual antiplatelet therapy with aspirin and clopidogrel. Methods and results. Thromboelastometry (ROTEM^®) on admission revealed low maximum clot firmness (MCF) in the FIBTEM assay, strongly indicating impaired fibrin polymerization. Inhibition of platelet activity also was confirmed. Massive intra-abdominal bleeding caused by a liver rupture required immediate laparotomy. Haemostasis during emergency surgery was achieved through topical surgical measures and intravenous fibrinogen concentrate administration (three doses of 4 g), guided by ROTEM test results only. As platelet count decreased to 28 × 10⁹ L⁻¹, 6 h after admission to the intensive care unit, the patient received two units of platelet concentrate. No further haemostatic therapy was necessary during the next 48 h. Conclusion. This case shows the potential effectiveness of fibrinogen concentrate in improving haemostasis in trauma patients receiving antiplatelet therapy.

Key Words::

• Trauma
• fibrinogen
• antiaggregant

Declarations of interest: Herbert Schöchl has received speaker fees from CSL Behring, GlaxoSmithKline and Tem International. Cristina Solomon has received speaker fees and research support from CSL Behring and Tem International. Cristina Solomon is study co-investigator in the study NCT00701142 investigating the haemostatic effect of fibrinogen concentrate in aortic aneurysm surgery. Alexander Hanke received speaker fees from CSL Behring. All other authors had no conflict of interest to declare.

Funding statement: The case report was prepared without external funding.

Patient permission: The patient described in this case report has provided written permission for publication of the report.