{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:45:56Z","timestamp":1791499556955,"version":"4.3.4"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Fibrinogen is the first coagulation factor to decrease after massive hemorrhage. European massive transfusion guidelines recommend early repletion of fibrinogen; however, this practice has not been widely adopted in the US. We hypothesize that hypofibrinogenemia is common at hospital arrival and is an integral component of trauma-induced coagulopathy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>STUDY DESIGN:<\/jats:title>\n            <jats:p>This study entailed review of a prospective observational database of adults meeting the highest-level activation criteria at an urban level 1 trauma center from 2014 through 2020. Resuscitation was initiated with 2:1 red blood cell (RBC) to fresh frozen plasma (FFP) ratios and continued subsequently with goal-directed thrombelastography. Hypofibrinogenemia was defined as fibrinogen below 150 mg\/dL. Massive transfusion (MT) was defined as more than 10 units RBC or death after receiving at least 1 unit RBC over the first 6 hours of admission.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Of 476 trauma activation patients, 70 (15%) were hypofibrinogenemic on admission, median age was 34 years, 78% were male, median New Injury Severity Score (NISS) was 25, and 72 patients died (15%). Admission fibrinogen level was an independent risk factor for MT (odds ratio [OR] 0.991, 95% CI 0.987\u20130.996]. After controlling for confounders, NISS (OR 1.034, 95% CI 1.017\u20131.052), systolic blood pressure (OR 0.991, 95% CI 0.983\u20130.998), thrombelastography angle (OR 0.925, 95% CI 0.896\u20130.954), and hyperfibrinolysis (OR 2.530, 95% CI 1.160\u20135.517) were associated with hypofibrinogenemia. Early cryoprecipitate administration resulted in the fastest correction of hypofibrinogenemia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION:<\/jats:title>\n            <jats:p>Hypofibrinogenemia is common after severe injury and predicts MT. Cryoprecipitate transfusion results in the most expeditious correction. Earlier administration of cryoprecipitate should be considered in MT protocols.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/xcs.0000000000000078","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T01:09:58Z","timestamp":1649120998000},"page":"465-473","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":54,"title":["Role of Fibrinogen in Trauma-Induced Coagulopathy"],"prefix":"10.1097","volume":"234","author":[{"given":"Jonathan P","family":"Meizoso","sequence":"first","affiliation":[{"name":"From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci)"},{"name":"Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest E","family":"Moore","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci)"},{"name":"Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric M","family":"Pieracci","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci)"},{"name":"Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A","family":"Saberi","sequence":"additional","affiliation":[{"name":"DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL (Saberi, Namias)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsen","family":"Ghasabyan","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci)"},{"name":"Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Chandler","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci)"},{"name":"Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Namias","sequence":"additional","affiliation":[{"name":"DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL (Saberi, Namias)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Sauaia","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci)"},{"name":"Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia)"},{"name":"University of Colorado, School of Public Health, Aurora, CO (Sauaia)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,2]]},"reference":[{"key":"R1-20250821","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/00005373-199502000-00006","article-title":"Epidemiology of trauma deaths: A reassessment.","volume":"38","author":"Sauaia","year":"1995","journal-title":"J Trauma"},{"key":"R2-20250821","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/TA.0000000000002205","article-title":"The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study.","volume":"86","author":"Callcut","year":"2019","journal-title":"J Trauma Acute 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