{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:11:06Z","timestamp":1791882666375,"version":"4.3.4"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Program of Korean Association for Research, Procedures and Education on Trauma","award":["KARPET-21-00"],"award-info":[{"award-number":["KARPET-21-00"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Fibrinogen concentrate (FC) can be administered during massive transfusions to manage trauma-induced coagulopathy. However, its effectiveness in survival remains inconclusive due to scarce high-level evidence. This study aimed to investigate the hemostatic effects of FC regarding mortality in massive hemorrhage caused by trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective study analyzed 839 patients who received massive transfusions (red blood cells (RBCs) \u22655 units in 4\u2009hours or \u226510 units in 24\u2009hours) at a level I trauma center between 2015 and 2022. Patients who were transferred to other hospitals or were deceased upon arrival, suffered or died from severe brain injury, and were aged 15 years or less were excluded (n=334). 1:2 propensity score matching was performed to compare the \u2018FC (+)\u2019 group who had received FC in 24\u2009hours (n=68) with those who had not (\u2018FC (\u2212)\u2019, n=437). The primary outcome was mortality, and the secondary outcomes included transfusion volume.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The variables for matching included vital signs, injury characteristics, prehospital time, implementation of resuscitative endovascular balloon occlusion of the aorta, and blood gas analysis results. The administration of FC did not significantly reduce or predict mortality (in-hospital, 24\u2009hours, 48\u2009hours, or 7\u2009days). The FC (\u2212) group received more units of RBC (25.69 units vs. 16.71 units, p&lt;0.001, standardized mean difference [SMD] 0.595), fresh frozen plasma (16.79 units vs. 12.91 units, p=0.023, SMD 0.321), and platelets (8.76 units vs. 5.46 units, p=0.002, SMD 0.446) than the FC (+) group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The use of FC did not show survival benefits but reduced transfusion requirements in traumatic massive hemorrhages, highlighting a need for future investigations. In the future, individualized goal-directed transfusion with FC may play a significant role in treating massive bleeding.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>IV, retrospective study having more than one negative criterion.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2023-001271","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T12:35:39Z","timestamp":1706618139000},"page":"e001271","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Hemostatic effect of fibrinogen concentrate on traumatic massive hemorrhage: a propensity score matching study"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-1794","authenticated-orcid":false,"given":"Yoonjung","family":"Heo","sequence":"first","affiliation":[{"name":"Division of Surgery, Department of Medicine, Dankook University Graduate School, Cheonan, Chungnam, Korea (the Republic of)"},{"name":"Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Wook","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Sung","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Department of Surgery, Dankook University College of Medicine, Cheonan, Chungnam, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"2025082410430652000_9.1.e001271.1","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.injury.2016.11.021","article-title":"Fibrinogen is an independent predictor of mortality in major trauma patients: a five-year statewide cohort study","volume":"48","author":"McQuilten","year":"2017","journal-title":"Injury"},{"key":"2025082410430652000_9.1.e001271.2","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1007\/s00134-022-06834-7","article-title":"Trauma-induced coagulopathy","volume":"48","author":"Kleinveld","year":"2022","journal-title":"Intensive Care Med"},{"key":"2025082410430652000_9.1.e001271.3","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/ACO.0000000000001027","article-title":"Fibrinogen in traumatic haemorrhage","volume":"34","author":"Winearls","year":"2021","journal-title":"Curr Opin Anaesthesiol"},{"key":"2025082410430652000_9.1.e001271.4","doi-asserted-by":"crossref","first-page":"e258","DOI":"10.1016\/S2352-3026(17)30077-7","article-title":"Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial","volume":"4","author":"Innerhofer","year":"2017","journal-title":"Lancet Haematol"},{"key":"2025082410430652000_9.1.e001271.5","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/ACO.0000000000001265","article-title":"Etiology and management of hypofibrinogenemia in trauma","volume":"36","author":"Nathwani","year":"2023","journal-title":"Curr Opin Anaesthesiol"},{"key":"2025082410430652000_9.1.e001271.6","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1080\/17474086.2021.1858788","article-title":"Hemostatic defects in massive transfusion: an update and treatment recommendations","volume":"14","author":"Napolitano","year":"2021","journal-title":"Expert Rev Hematol"},{"key":"2025082410430652000_9.1.e001271.7","unstructured":"American College of Surgeons . 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