- Human Fibrinogen (RiaSTAP) is a blood product derivative.
- Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes1.
- Suspected or obvious traumatic haemorrhage necessitating pre-hospital blood product transfusion
AND
- A point of care INR of ≥ 1.2
- RiaSTAP®, Fibrinogen Concentrate (Human), is contraindicated in patients with known anaphylactic or severe systemic reactions to human plasma-derived products
- The most serious adverse reactions observed are thrombotic episodes (pulmonary embolism, myocardial infarction, deep vein thrombosis) and anaphylactic reactions.
- The most common adverse reactions observed in clinical studies (frequency >1%) were fever and headache
- RiaSTAP® is a blood product and therefore must not be administered to non-consenting conscious patients (i.e. Jehovahs Witness)
- Medications administered intermittently rather than continuously may be administered via the same line providing the line is flushed with 0.9% saline both prior to and after administering the medication.
- Prepare RiaSTAP® by placing vials on flat, firm surface and removing caps from vials.
- Disinfect rubber stoppers with chlorhexidine/isopropyl alcohol swab and allow to dry
- Open supplied Transofix® transfer device and remove safety cap
- Penetrate rubber stopper of water vial with Transofix® spike, and remove remaining safety cap from the device
- Invert RiaSTAP® vial and penetrate rubber stopper withexposed Transofix® spike
- Gently angle the interconnected vials to encourage the water to run slowly into the uppermost part of RiaSTAP® vial. Do NOT allow water to pour directly onto RiaSTAP® powder.
- When all water transferred, disconnect from RiaSTAP vial and GENTLY swirl the vial to fully reconstitute the contents (may take 5-10 minutes). Do NOT shake the vial.
- Following reconstitution, RiaSTAP® should be a colourless and clear to slightly opalescent liquid. Inspect for particulate matter prior to administration. Do NOT use if solution is cloudy or contains particulate matter.
- Gently withdraw reconstituted RiaSTAP® from vial using 50ml syringe to achieve final concentration of 1g/50ml.
| kg | ||
| Mode: | ||
| Weight: | ||
| Cefazolin for fractures/prophylaxis |
| Presentation: /mL |
| Calculated dose: in |
In critical bleeding situations, administer the below as a slow IV push over 2–4 minutes/g, i.e. 50mL over 2–4 minutes.
Adults
| Weight | Dose | Volume |
|---|---|---|
| < 75kg | 2g | 100mL |
| > 75kg | 3g | 150mL |
Paediatrics
- ASMA Consult required
- 70mg/kg to a maximum of 2g
- The use of RiaSTAP® is only beneficial in trauma for patients with confirmed low fibrinogen levels
- Approximately 75% of patients will have correction of coagulopathy and bleeding after a single dose of 50mg/kg
- The lot numbers of all RiaSTAP® vials administered to the patient should be recorded in the patients ePCR
Vials (powder and solvent):
- 1g human fibrinogen (RiaSTAP®)
- 50ml water for injection
| Settings | |
|---|---|
| Current mode: | |
| Extended Care: | |
| Colour assist: | |
Mengoli C, Franchini M, Marano G, et al. 2017. The use of fibrinogen concentrate for the management of trauma-related bleeding: a systematic review and meta-analysis. Blood Transfus;15(4):318-324. doi:10.2450/2017.0094-17
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