Eficacia del fibrinógeno versus complejos de concentrados protrombóticos en el tratamiento de hemorragia aguda en pacientes politraumatizados. Revisión sistemática

Abstract

Acute hemorrhage is a heterogeneous condition associated with significant mortality in young adults. Viscoelastic tests demonstrate high sensitivity and specificity in detecting hypofibrinogenemia and guiding massive transfusion protocols. The first-line pharmacological tool is tranexamic acid; however, the current paradigm emphasizes administering hemostatic agents, such as fibrinogen concentrate and prothrombin complexes, to effectively manage massive bleeding and coagulation abnormalities. In Ecuador, hemostatic agents are limited to tertiary-level hospitals due to their cost. Nonetheless, the health system employs fibryga (recombinant fibrinogen complex) and octaplex (prothrombin complex). Objective: To compare the efficacy of fibrinogen versus prothrombin complex concentrates in managing acute hemorrhage in polytraumatized patients. Methodology: This retrospective and descriptive study follows PRISMA guidelines. Bias assessment was conducted using Cochrane Review Manager and NHLBI tools. Fourteen articles were analyzed and retrieved from scientific databases such as Cochrane, Scopus, PubMed, Taylor & Francis, and UpToDate. Results: Prothrombin complexes demonstrated hemostatic efficacy in 85.8% of patients with life-threatening hemorrhage, including cerebral and gastrointestinal bleeding and anticoagulant reversal, at doses of 1 ml/kg (25 IU/kg). In contrast, fibrinogen concentrate was effective in pure hypofibrinogenemia states at doses of 1 to 4 grams in adults, adjusted based on serum fibrinogen levels (greater than 200 mg/dL).