Worldwide, hemorrhage contributes to at least half of the 4.4 million trauma deaths annually. Recent studies have found that either whole blood or a ratio of blood components similar to whole blood reduces mortality for hemorrhaging trauma patients. In addition, cryoprecipitate is now given as part of standard care once other blood component transfusions have been initiated. Pilot and observational studies have suggested that early, high-dose cryoprecipitate may reduce mortality by addressing low levels of fibrinogen commonly found in hemorrhaging trauma patients. To test this hypothesis, researchers in the U.K. and the U.S. enrolled 1604 adult trauma patients (mean age, 39 years; 79% men; median Injury Severity Score, 29) and randomized them 1:1 to receive either three pools of high-dose cryoprecipitate (~6 g fibrinogen) (n=799) as soon as possible along with standard care (including massive transfusion protocols when needed) or standard care (n=805). The risk of mortality at day 28, however, was similar in both groups—25.3% in the cryoprecipitate group compared to 26.1% in the standard care group (odds ratio, 0.96). However, less than a quarter of the patients required massive transfusions, and it is unclear how many patients experienced hypofibrinogenemia. Further studies are needed on early, high-dose cryoprecipitate for hemorrhage after traumatic injury.
References:
- Davenport R, Curry N, Fox EE, et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. Published online October 12, 2023.
- Tisherman SA, Brenner ML. Contemporary Adjuncts to Hemorrhage Control. Published online October 12, 2023.
