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Title: Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review
Authors: Maconachie, Sharon 
Jansen, Melanie
Cottle, Emma
Roy, John 
Ross, Bryony
Winearls, James 
George, Shane 
Issue Date: Apr-2020
Publisher: Wiley
Source: Maconachie S, Jansen M, Cottle E, Roy J, Ross B, Winearls J, George S. Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review. Emerg Med Australas. 2020 Apr;32(2):313-319. doi: 10.1111/1742-6723.13484. Epub 2020 Mar 9. PMID: 32153133.
Journal: Emergency medicine Australasia : EMA
Abstract: Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paediatric population, there has been limited uptake of these principles and a paucity of data to support a change in practice. This paper summarises the available evidence in the published literature through a systematic review, presented in narrative format. There is limited high-quality prospective data on the use of VHA in the management of acute traumatic coagulopathy in the paediatric population. While the use of fibrinogen early in major haemorrhage is becoming standard practice, there are currently no randomised prospective studies comparing fibrinogen concentrate to cryoprecipitate. The early identification of hypo-fibrinogenemia and acute traumatic coagulopathy in paediatric trauma using VHA testing and subsequent early fibrinogen replacement with a concentrated off the shelf product is an attractive treatment option. However, there is currently insufficient high-level evidence to support the use of fibrinogen concentrate over cryoprecipitate in the paediatric trauma population. Pilot studies currently under way will go some way to addressing this important knowledge gap, and facilitate the design of larger definitive multi-centre randomised trials.
DOI: 10.1111/1742-6723.13484
Keywords: Haemorrhage;Paediatric trauma;Fibrinogen;Coagulopathy .;Viscoelastic haemostatic assay
Type: Article
Appears in Sites:Gold Coast Health Publications

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