Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group

Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C.

Risultato della ricerca: Article

6 Citazioni (Scopus)

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.
Lingua originaleEnglish
pagine (da-a)e0164090-
Numero di pagine19
RivistaPLoS One
Volume11
Stato di pubblicazionePublished - 2016

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systematic review
Tranexamic Acid
Blood
therapeutics
Mortality
blood
Wounds and Injuries
Fibrinogen
Cells
Plasmas
fibrinogen
Testing
observational studies
Therapeutics
Observational Studies
acids
erythrocytes
Erythrocytes
Association reactions
PubMed

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cita questo

Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C. (2016). Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group. PLoS One, 11, e0164090-.

Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group. / Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C.

In: PLoS One, Vol. 11, 2016, pag. e0164090-.

Risultato della ricerca: Article

Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C. 2016, 'Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group', PLoS One, vol. 11, pagg. e0164090-.
Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C. Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group. PLoS One. 2016;11:e0164090-.
Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C. / Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group. In: PLoS One. 2016 ; Vol. 11. pagg. e0164090-.
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title = "Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group",
abstract = "Background 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. Methods 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. Results 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. Conclusions 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.",
keywords = "Antifibrinolytic Agents; Blood Coagulation Disorders; Humans; Mortality; Plasma Exchange; Tranexamic Acid; Wounds and Injuries; Blood Component Transfusion; Biochemistry, Genetics and Molecular Biology (all); Agricultural and Biological Sciences (all)",
author = "{Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimbanassi, S.; Cingolani, E.; Monesi, A.; Sanson, G.; Tacconi, C.} and {De Blasio}, Anna and Andrea Cortegiani",
year = "2016",
language = "English",
volume = "11",
pages = "e0164090--",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",

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TY - JOUR

T1 - Blood component therapy and coagulopathy in trauma: A systematic review of the literature from the trauma update group

AU - Poole, D.; Chieregato, A.; Russo, E.; Pellegrini, C.; Mengoli, F.; Volpi, A.; Grossi, S.; Gianesello, L.; Orzalesi, V.; Fossi, F.; Chiara, O.; Coniglio, C.; Gordini, G.; Blasio, D.; Nardi, G.; Agostini, V.; Bini, G.; Cimb

AU - De Blasio, Anna

AU - Cortegiani, Andrea

PY - 2016

Y1 - 2016

N2 - Background 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. Methods 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. Results 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. Conclusions 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.

AB - Background 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. Methods 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. Results 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. Conclusions 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.

KW - Antifibrinolytic Agents; Blood Coagulation Disorders; Humans; Mortality; Plasma Exchange; Tranexamic Acid; Wounds and Injuries; Blood Component Transfusion; Biochemistry, Genetics and Molecular Biology (all); Agricultural and Biological Sciences (all)

UR - http://hdl.handle.net/10447/273004

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M3 - Article

VL - 11

SP - e0164090-

JO - PLoS One

JF - PLoS One

SN - 1932-6203

ER -