Comprehensive Summary
In their article, Da Luz et al. (2025) compared outcomes in patients with trauma-induced coagulopathy (TIC) following the administration of either fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC), or plasma transfusions. The FiiRST-2 trial conducted at six level 1 trauma centers in Canada between 2021 and 2023, enrolled 217 patients and collected data on outcomes and allogeneic blood product (ABP) administration. The primary was the number of ABP units transfused within 24 hours; secondary outcomes included incidence of thromboembolic events (TEE), duration of ICU stay, and mortality. Overall, there was no significant difference in the primary outcome, with the FC-PCC group receiving a mean of 20.8 ABP units within 24 hours compared to 23.8 units in the plasma group. Similarly, no significant differences were observed in secondary outcomes: 24 hour mortality was 5 versus 12 (P = 0.24), and 14 TEEs occurred in comparison to 10 (P = 0.37) in the FC-PCC and plasma groups, respectively. Given these inconclusive results, Da Luz et al. recommend that future trials focus on optimizing patient selection for ABP therapy, as a definitive advantage of one protocol over another is unlikely to be established.
Outcomes and Implications
Determining the optimal management strategy to treat TIC is complex and is unlikely to yield a single definitive solution. Testing to determine the optimal transfusion protocol can take up to 60 minutes, posing a challenge in time-sensitive trauma resuscitation and underscoring the need for efficient decision-making frameworks. Furthermore, urban centers often have the capacity to store and thaw AB plasma, whereas rural facilities may lack this capability. An advantage of FC and PCC over plasma is their relative ease and speed of administration, requiring less preparation time. In the absence of significant clinical differences, optimizing TIC management may depend more on logistical feasibility than on differences in therapeutic outcomes.