Table 2.
Trigger thresholds and transfusion in trauma surgery using VHA algorithms.
| Author (year) | Sample size | Research type | Reduction of blood product | VHA | FC/fibrinogen/ cryoprecipitate | FFP/PLASMA/PCC | PLT | TXA | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Trigger value | Dosage | Trigger value | Dosage | Trigger value | Dosage | Trigger value | Dosage | |||||
| David et al. (2023) (5) | n = 624 | Retrospective | Yes | ROTEM | FIBTEM A5: 7–8 mm | Fibrinogen 25 mg/kg | EXTEM CT > 106 s | 107–135 s → FFP10 ml/kg OR PCC10 μl/kg 136–200 s → FFP20 ml/kg OR PCC20 μl/kg > 200 s → FFP20 ml/kg AND PCC20 Ul/k | FIBTEM A5 > 9 mm | PLT | EXTEM ML > 15% | TXA 1 g |
| FIBTEM A5 < 7 mm | Fibrinogen 5–6 mm= 25 mg/kg < 5 mm = 50 mg/kg | EXTEM CT > 90 s AND FIBTEM A5 > 6 mm | FFPs/PCCs | |||||||||
| Barquero López et al. (2022) (29) | n = 135 | Retrospective | Yes | ROTEM | EXTEM A10 ≤ 40 mm FIBTEM A10 ≤ 7 mm | Fibrinogen: FIBTEM goal-current FIBTEM x (Kg/140) = grams needed (mm) | EXTEM CT> 80 s | PCC: 500–1,000 IU | EXTEM A10 ≤ 40 mm FIBTEM A10 > 7 mm PLT < 50.000–75.000/μl | 1 PLTs concentrate | ML > 15% | TAX 1 g |
| George et al. (2022) (30) | n = 167 | Retrospective | NA | ROTEM | FIBTEM A5 ≤ 10 mm | FC: 50 mg/kg | FIBTEM A5 > 10 mm AND EXTEM CT ≥ 90 s | FFP1: 5 ml/kg | FIBTEM A5 > 10 mm AND EXTEM A5 ≤ 35 mm | PLTs: 10–15 ml/kg | FIBTEM CT > 300 s AND EXTEM A5 ≤ 35 mm | TXA: 15 mg/kg + FC: 50 mg/Kg |
| Cryoprecipitate:5 ml/kg | PCC: 10 IU/Kg | ML ≥ 5% | TXA: 15 mg/kg (max 1 g) | |||||||||
| Spagnolello et al. (2021) (31) | n = 57 | Prospective observational | NA | ROTEM | \ | \ | EXTEM A10 ≥ 39 mm (A5 ≥ 28 mm) AND FIBTEM A10 < 5 mm (A5 ≤ 3 mm) | FFP: 4 unit | FIBTEM A10 ≥ 8 mm (A5 ≥ 7 mm) | PLT | \ | \ |
| Cochrane et al. (2020) (28) | n = 301 | Prospective observational | Yes | TEG | CFF MA < 14 mm AND CRT MA < 50 mm | Three pools cryoprecipitate | CRT ACT ≥ 120 s | FFP/octoplas: 12–15 | CRT MA < 60 mm AND CFF MA ≥ 14 mm | PLTs one pool | CRT LY30 ≥ 3% | TAX: 1 g OR 10 mg/kg |
| CFF MA < 14 mm AND CRT MA ≥50 mm | Two pools cryoprecipitate | |||||||||||
| Baksaas-Aasen et al. (2017) (10) | n = 392 | RCT | NA | ROTEM | FIBTEM A5 < 10 mm | 4 g equivalent of fibrinogen | EXTEM A5 > 40 mm AND EXTEM CT > 80 s | 4 units of plasma | (EXTEM A5 -FIBTEM A5) < 30 mm | One pool of PLTs | EXTEM LI30 < 85 % | 1 g TXA |
| TEG | MA < 20 mm | 4 g equivalent of fibrinogen | rTEG MA ≥ 65 mm AND rTEG AC0T > 120 s | 4 units of plasma | (rTEG MA- FF TEG MA) < 45 mm | One pool of PLTs | rTEG LY30 > 10 % | 1 g TXA | ||||
FC, fibrinogen concentrate; FFP, fresh frozen plasma; PCC, prothrombin complex concentrate; PLT, platelet; TXA, tranexamic acid; FIBTEM, fibrinogen thromboelastometry; EXTEM, external thromboelastometry; CT, time from test start to an amplitude of 2 mm; CFF, citrated functional fibrinogen; CRT, citrated rapid TEG; ACT, TEG activated clotting time; rTEG, rapid TEG; LI30, percentage of clot lysis at 30 min; LY30, percentage of clot lysis at 30 min; A10, the clot amplitude at 10 min after the beginning of clot formation; A5, the clot amplitude at 5 min after the beginning of clot formation; MA, maximum clot strength.