High-dose fibrinogen concentrate for haemostatic therapy of a major trauma patient with recent clopidogrel and aspirin intake

INTRODUCTION: We report on a severely injured trauma patient who suffered a high velocity motorcycle accident. The patient was receiving dual antiplatelet therapy with aspirin and clopidogrel. METHODS AND RESULTS: Thromboelastometry (ROTEM(®)) on admission revealed low maximum clot firmness (MCF) in the FIBTEM assay, strongly indicating impaired fibrin polymerization. Inhibition of platelet activity also was confirmed. Massive intra-abdominal bleeding caused by a liver rupture required immediate laparotomy. Haemostasis during emergency surgery was achieved through topical surgical measures and intravenous fibrinogen concentrate administration (three doses of 4 g), guided by ROTEM test results only. As platelet count decreased to 28 × 10(9) L(-1), 6 h after admission to the intensive care unit, the patient received two units of platelet concentrate. No further haemostatic therapy was necessary during the next 48 h. CONCLUSION: This case shows the potential effectiveness of fibrinogen concentrate in improving haemostasis in trauma patients receiving antiplatelet therapy.