Objectives of the new Austrian guidelines for trauma-related bleeding management include the restriction of allogeneic blood products, consideration of the cell-based model of haemostasis, the use of point-of-care coagulation monitoring and of effective coagulation factor concentrates. E.g., measurement and correction of fibrinogen concentration < 1,5-2 g/l and/or diminished fibrin polymerization in the thrombelastometric FIBTEM assay is recommended in bleeding trauma patients. If FFP is used in massive coagulopathic bleeding about 30 ml/kg BW is required.

The use of coagulation factors concentrate for haemostatic therapy is encouraged for several reasons: transfusion of allogeneic blood products is associated with a number of adverse events; allogeneic blood products such as FFP lack efficacy in the correction of coagulation abnormalities; in vivo haemodilution decreases the concentration of fibrinogen, FII, FVII, and FXIII more than predicted by the degree of haemodilution. Prothrombin complex concentrate represents the state of the art in the acute reversal of vitamin K antagonist therapy. Fibrinogen concentrate has been shown to correct reduced clot firmness induced by haemodilution and to reduce transfusion requirements. Intraoperative administration of FXIII has been shown to improve clot firmness and reduce blood loss.

Recombinant activated factor VII has a licensed indication in haemophilia with inhibiting antibodies and Glanzmann's disease. Despite controversial study results, national and international guidelines for trauma-related bleeding management recommend off-label administration of recombinant activated factor VII in persisting bleeding (grade 2C) only after preconditioning of the patient with adequate fibrinogen, platelet concentrates and acidosis correction. Thrombotic events are a potential complication of recombinant activated factor VII.

A large proportion of severely traumatized patients are coagulopathic on arrival in the emergency room. The ratio of FFP:RBC administered for the treatment of bleeding in trauma patients may have an impact on survival, but the optimal ratio is unknown. Fibrinogen plays an important role in the management of trauma coagulopathic bleeding, because severe tissue trauma leads to a substantial consumption of fibrinogen. It has been shown that a high ratio of fibrinogen:RBC improves the survival of trauma patients. Application of a ROTEM-based coagulation management concept using fibrinogen concentrate and prothrombin complex concentrate may reduce transfusion and may have a positive effect on survival.