Objective To quantify the impact of fibrinogen-containing cryoprecipitate
in addition to the antifibrinolytic tranexamic acid on survival in
Design Retrospective observational study comparing the mortality of
4 groups: tranexamic acid only, cryoprecipitate only, tranexamic acid
and cryoprecipitate, and neither tranexamic acid nor cryoprecipitate.
To balance comparisons, propensity scores were developed and added
as covariates to logistic regression models predicting mortality.
Setting A Role 3 Combat Surgical Hospital in southern Afghanistan.
Patients A total of 1332 patients were identified from prospectively
collected UK and US trauma registries who required 1 U or more of
packed red blood cells and composed the following groups: tranexamic
acid (n = 148), cryoprecipitate (n = 168), tranexamic
acid/cryoprecipitate (n = 258), and no tranexamic acid/cryoprecipitate
(n = 758).
Main Outcome Measure In-hospital mortality.
Results Injury Severity Scores were highest in the cryoprecipitate (mean
[SD], 28.3 [15.7]) and tranexamic acid/cryoprecipitate (mean [SD],
26 [14.9]) groups compared with the tranexamic acid (mean [SD], 23.0
[19.2]) and no tranexamic acid/cryoprecipitate (mean [SD], 21.2 [18.5])
(P < .001) groups. Despite greater
Injury Severity Scores and packed red blood cell requirements, mortality
was lowest in the tranexamic acid/cryoprecipitate (11.6%) and tranexamic
acid (18.2%) groups compared with the cryoprecipitate (21.4%) and
no tranexamic acid/cryoprecipitate (23.6%) groups. Tranexamic acid
and cryoprecipitate were independently associated with a similarly
reduced mortality (odds ratio, 0.61; 95% CI, 0.42-0.89; P = .01 and odds ratio, 0.61; 95% CI, 0.40-0.94; P = .02, respectively). The combined
tranexamic acid and cryoprecipitate effect vs neither in a synergy
model had an odds ratio of 0.34 (95% CI, 0.20-0.58; P < .001), reflecting nonsignificant interaction
(P = .21).
Conclusions Cryoprecipitate may independently add to the survival benefit
of tranexamic acid in the seriously injured requiring transfusion.
Additional study is necessary to define the role of fibrinogen in
resuscitation from hemorrhagic shock.