Intravenous Haemostatic Adjuncts

This chapter summarises the evidence base for use of tranexamic acid, prothrombin complex concentrate (PCC), fibrinogen concentrate, cryoprecipitate and recombinant Factor VII a in trauma. The use of tranexamic acid within 3 hours of trauma has clear outcome benefits at a low cost, and on-going research appears to support a role for this agent in the pre-hospital setting. There is evolving evidence for the use of fibrinogen concentrates and cryoprecipitate, including within initial resuscitation. Further studies are required to determine the role for these agents either instead of, or in conjunction with, plasma. There is limited data to support the use of PCC in the trauma setting at present and care must be taken with potential risks, including the precipitation of disseminated intravascular coagulation. Factor VIIa should be reserved as a salvage intervention where life-threatening bleeding has been unresponsive to all other measures. The ongoing development of algorithmic and viscoelastic testing-based approaches to the management of trauma-induced coagulopathy will permit targeted administration of these agents with consequent improvements in efficacy and safety. However, further studies are required to assess the cost-effectiveness of these approaches in trauma.