BACKGROUND: Coagulopathy is present in 25% to 38% of trauma patients on arrival to the hospital, and these patients are four times more likely to die than trauma patients without coagulopathy. Recently, a high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBCs) has been shown to decrease mortality in massively transfused trauma patients. Therefore, we hypothesized that patients with elevated International Normalized Ratio (INR) on arrival to the hospital may benefit more from transfusion with a high ratio of FFP:PRBC than those with a lower INR. METHODS: Retrospective multicenter cohort study of 437 massively transfused trauma patients was conducted to determine whether the effect of the ratio of FFP:PRBC on death at 24 hours is modified by a patient's admission INR on arrival to the hospital. Contingency tables and logistic regression were used. RESULTS: Trauma patients who arrived to the hospital with an elevated INR had a greater risk of death than those with a lower INR. However, as the ratio of FFP:PRBC transfused increased, mortality decreased similarly between the INR quartiles. CONCLUSIONS: The mortality benefit from a high FFP:PRBC ratio is similar for all massively transfused trauma patients. This is contrary to the current belief that only coagulopathic trauma patients benefit from a high FFP:PRBC ratio. Furthermore, it is unnecessary to determine whether INR is elevated before transfusing a high FFP:PRBC ratio. Future studies are needed to determine the mechanism by which a high FFP:PRBC ratio decreases mortality in all massively transfused trauma patients.
BACKGROUND:Coagulopathy is present in 25% to 38% of traumapatients on arrival to the hospital, and these patients are four times more likely to die than traumapatients without coagulopathy. Recently, a high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBCs) has been shown to decrease mortality in massively transfused traumapatients. Therefore, we hypothesized that patients with elevated International Normalized Ratio (INR) on arrival to the hospital may benefit more from transfusion with a high ratio of FFP:PRBC than those with a lower INR. METHODS: Retrospective multicenter cohort study of 437 massively transfused traumapatients was conducted to determine whether the effect of the ratio of FFP:PRBC on death at 24 hours is modified by a patient's admission INR on arrival to the hospital. Contingency tables and logistic regression were used. RESULTS:Traumapatients who arrived to the hospital with an elevated INR had a greater risk of death than those with a lower INR. However, as the ratio of FFP:PRBC transfused increased, mortality decreased similarly between the INR quartiles. CONCLUSIONS: The mortality benefit from a high FFP:PRBC ratio is similar for all massively transfused traumapatients. This is contrary to the current belief that only coagulopathic traumapatients benefit from a high FFP:PRBC ratio. Furthermore, it is unnecessary to determine whether INR is elevated before transfusing a high FFP:PRBC ratio. Future studies are needed to determine the mechanism by which a high FFP:PRBC ratio decreases mortality in all massively transfused traumapatients.
Authors: Matthew A Borgman; Philip C Spinella; Jeremy G Perkins; Kurt W Grathwohl; Thomas Repine; Alec C Beekley; James Sebesta; Donald Jenkins; Charles E Wade; John B Holcomb Journal: J Trauma Date: 2007-10
Authors: John B Holcomb; Charles E Wade; Joel E Michalek; Gary B Chisholm; Lee Ann Zarzabal; Martin A Schreiber; Ernest A Gonzalez; Gregory J Pomper; Jeremy G Perkins; Phillip C Spinella; Kari L Williams; Myung S Park Journal: Ann Surg Date: 2008-09 Impact factor: 12.969
Authors: Joseph F Kelly; Amber E Ritenour; Daniel F McLaughlin; Karen A Bagg; Amy N Apodaca; Craig T Mallak; Lisa Pearse; Mary M Lawnick; Howard R Champion; Charles E Wade; John B Holcomb Journal: J Trauma Date: 2008-02
Authors: John B Holcomb; Neil R McMullin; Lisa Pearse; Jim Caruso; Charles E Wade; Lynne Oetjen-Gerdes; Howard R Champion; Mimi Lawnick; Warner Farr; Sam Rodriguez; Frank K Butler Journal: Ann Surg Date: 2007-06 Impact factor: 12.969
Authors: Ayesha Imam; Guang Jin; Martin Sillesen; Simone E Dekker; Ted Bambakidis; John O Hwabejire; Cecilie H Jepsen; Ihab Halaweish; Hasan B Alam Journal: J Neurotrauma Date: 2014-12-19 Impact factor: 5.269
Authors: Matthew E Kutcher; Lucy Z Kornblith; Ryan F Vilardi; Brittney J Redick; Mary F Nelson; Mitchell Jay Cohen Journal: Ann Surg Date: 2014-12 Impact factor: 12.969
Authors: Rachael A Callcut; Bryan A Cotton; Peter Muskat; Erin E Fox; Charles E Wade; John B Holcomb; Martin A Schreiber; Mohammad H Rahbar; Mitchell J Cohen; M Margaret Knudson; Karen J Brasel; Eileen M Bulger; Deborah J Del Junco; John G Myers; Louis H Alarcon; Bryce R H Robinson Journal: J Trauma Acute Care Surg Date: 2013-01 Impact factor: 3.313
Authors: Hunter B Moore; Ernest E Moore; Michael P Chapman; Kevin McVaney; Gary Bryskiewicz; Robert Blechar; Theresa Chin; Clay Cothren Burlew; Fredric Pieracci; F Bernadette West; Courtney D Fleming; Arsen Ghasabyan; James Chandler; Christopher C Silliman; Anirban Banerjee; Angela Sauaia Journal: Lancet Date: 2018-07-20 Impact factor: 79.321
Authors: Angela Sauaia; Ernest E Moore; Jeffrey L Johnson; Theresa L Chin; Anirban Banerjee; Jason L Sperry; Ronald V Maier; C Cothren Burlew Journal: J Trauma Acute Care Surg Date: 2014-03 Impact factor: 3.313
Authors: Mitchell Jay Cohen; Matt Kutcher; Britt Redick; Mary Nelson; Mariah Call; M Margaret Knudson; Martin A Schreiber; Eileen M Bulger; Peter Muskat; Louis H Alarcon; John G Myers; Mohammad H Rahbar; Karen J Brasel; Herb A Phelan; Deborah J del Junco; Erin E Fox; Charles E Wade; John B Holcomb; Bryan A Cotton; Nena Matijevic Journal: J Trauma Acute Care Surg Date: 2013-07 Impact factor: 3.313