Fixed ratio versus goal-directed therapy in trauma

This article compares the strategy of a fixed transfusion ratio of plasma and platelet concentrates to red blood cells to reconstitute 'whole blood' with the concept of individualized goal-directed coagulation therapy (GDCT).

Current data suggest that an early and high ratio of plasma and platelet concentrate transfusion, predominantly in a fixed 1 : 1 : 1 ratio with red blood cells, is associated with improved outcome. However, the optimal ratio is still under discussion. Moreover, storage time considerably affects the hemostatic competence of these products and no universal standard for the composition of these 'transfusion packages' has been established. Some European trauma centers instituted the concept of GDCT in trauma patients, which is based on early diagnosis of the coagulation deficit using point-of-care viscoelastic tests (VETs). These tests provide rapid information about the underlying hemostatic deficiencies, allowing targeted coagulation therapy according to the individual deficits of the patient. Treatment algorithms have been established for the administration of coagulation factor concentrates, and plasma and platelet concentrate based on VET results.

Individualized GDCT, guided by VET, offers several advantages over fixed ratio coagulation therapy. Studies comparing both hemostatic strategies are warranted.