Clinical Benefits of Early Concurrent use of Cryoprecipitate and Plasma Compared with Plasma only in Bleeding Trauma Patients: Analysis of the Trauma Quality Improvement Program Database

Abstract Background:The effectiveness of cryoprecipitate in trauma has not been well-established. In addition, the benefits of cryoprecipitate might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. This study aimed to evaluate the benefits of the concurrent use of cryoprecipitate in combination with fresh frozen plasma (FFP) during the resuscitation of bleeding trauma patients.Methods: A retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database was conducted. Patients who received ≥4 units of packed red blood cells within the first 4 hours after arrival to the emergency department (ED) were dichotomized according to whether cryoprecipitate was used. The outcomes (primary: in-hospital mortality; secondary: 24-h mortality and incidence of complications) were compared using propensity score-matching analysis, in which the amount of total administered clotting factors was balanced.Results: A total of 19,008 patients (Cryo+FFP group: 3825; FFP only group: 15,183) were eligible for analysis, of whom 3103 propensity score-matched pairs were generated. Significantly lower in-hospital mortality (1217 [39.2%] patients in the Cryo+FFP group vs. 1295 [41.7%] in the FFP only group; odds ratio [OR], 0.90; 95% CI, 0.81-1.00) and 24-h mortality (735 [23.7%] vs. 886 [28.6%]; OR, 0.78; 95% CI, 0.69-0.87) were observed in the Cryo+FFP group than in the FFP only group; no significant difference was observed in the incidence of complications. Conclusions: Cryoprecipitate use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients after adjustments were made for the dose of administered clotting factors. Future randomized controlled trials are warranted to confirm our results.