[Coagulation management in major trauma]

In trauma associated coagulopathy, the initial treatment consists of hypothermia and acidosis have to be treated aggressively. Already in in the emergency room, fibrinogen deficiency can be detected frequently, in addition, colloids interfere with fibrin polymerisation. Under these aspects, the early administration of fibrinogen seems to be justified. Depleted coagulation factors can be substituted with PPSB and/or fresh frozen plasma, while in view of a risk of infection, retaining administration of platelet concentrates is indicated. The potential of using haemostatic agents like antifibrinolytics and DDAVP for this indication is only supported by few studies, although in individual cases it may be very helpful. The administration of recombinant FVIIa could not achieve sustainable amelioration of the outcome of trauma patients in a randomised controlled trial. Raising inhibitors of coagulation (antithrombin) simultaneously to antihaemorragic therapy is being discussed, but seems not reasonable in the acute phase of a life-threatening haemorrage.