Early coagulation support protocol: A valid approach in real-life management of major trauma patients. Results from two Italian centres

Bocci, Maria Grazia; Veronesi, Giovanni; Rondinelli, Maria Beatrice; Palma, Antonella; Fiore, Valentina; Candia, Erica De; Bianchi, Maria; Maresca, Maddalena; Barelli, Roberta; Tersali, Alessandra; Dell’Anna, Antonio Maria; Pascale, Gennaro De; Cutuli, Salvatore Lucio; Mercurio, G; Caricato, Anselmo; Grieco, Domenico Luca; Antonelli, Massimo; Cingolani, E

doi:10.1016/j.injury.2019.09.032

Cited by 10 publications

(8 citation statements)

References 42 publications

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“…In case of severe and life-threatening hemorrhage under preinjury factor-Xa inhibition, the recommended treatment is combined TXA 15 mg/kg (or 1 g) and PCC (25-50 units/kg) (R34/2C). The European Medicines Agency (EMA) supported the approval of factor-Xa antidote andexanet alfa and the agent became available in most European countries [160].…”

Section: Hints For Therapymentioning

confidence: 99%

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

et al. 2021

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Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

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Section: Hints For Therapymentioning

confidence: 99%

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

et al. 2021

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“…A recently published retrospective study observed that early coagulation support was associated with reduced transfusion rates of erythrocyte concentrates (ECs) and shorter length of stay (LOS) ( 43 ). An increased plasma usage needs to be accepted, as most fixed transfusion protocols are based on this concept ( 42 ).…”

Section: Resultsmentioning

confidence: 99%

“…Fibrinogen supplementation can be conducted using FFP, cryoprecipitate, and ﬁbrinogen concentrate. In FFP, fibrinogen levels are highly variable, which may lead to large amounts of fluid to restore ﬁbrinogen levels, subsequently causing haemodilution worsening of coagulation ( 43 ). Furthermore, no clear superiority of either cryoprecipitate or fibrinogen has been shown concerning treatment efficacy ( 100 ).…”

Section: Resultsmentioning

confidence: 99%

Coagulopathy management of multiple injured patients – a comprehensive literature review of the European guideline 2019

et al. 2022

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The European guideline on the management of trauma-induced major bleeding and coagulopathy summarises the most relevant recommendations for trauma coagulopathy management. The management of trauma-induced major bleeding should interdisciplinary follow algorithms which distinguish between life-threatening and non-life-threatening bleeding. Point-of-care viscoelastic methods (VEM) assist target-controlled haemostatic treatment. Neither conventional coagulation assays nor VEM should delay treatment in life-threatening trauma-induced bleeding. Adjustments may be rational due to local circumstances, including the availability of blood products, pharmaceuticals, and employees.

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“…Trotz Kritik an methodischen Schwächen der Studie [ 4 , 38 ] sowie Hinweisen auf eine erhöhte Inzidenz von VTE in anderen Studien [ 22 , 37 , 57 ] etablierte sich die Dosierung von 1 g TXA als i.v.-Bolus und einer kontinuierlichen Gabe von 1 g i.v. über 8 h in verschiedenen Leitlinien und Empfehlungen [ 6 , 39 , 43 , 51 ] im Sinne einer frühen bzw. im engeren Sinne prophylaktischen Gabe bei schwerem Trauma.…”

Section: Tranexamsäure Bei Trauma Und Schädel-hirn-traumaunclassified

Tranexamsäure zur Blutungsprophylaxe bei Trauma und orthopädischen Eingriffen – Standard oder individualisierte Anwendung?

Pekrul¹,

Schachtner

Zwißler³

et al. 2021

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ZusammenfassungTranexamsäure hat einen etablierten Stellenwert in der Behandlung von Blutungen, v. a. bei Hyperfibrinolyse. Zunehmend wird TXA auch prophylaktisch bei Trauma und orthopädischen Eingriffen eingesetzt, wobei sich Fragen nach Risiken sowie einem möglichen Off-Label-Einsatz ergeben. Auf Basis der verfügbaren Literatur lässt sich schließen, dass ein prophylaktischer Einsatz des Präparates in diesen Indikationsbereichen vertretbar ist. Jedoch sollte bei Patienten mit erhöhtem Risiko für thrombembolische Ereignisse weiterhin eine individuelle Abwägung von Nutzen und Risiken durchgeführt und dokumentiert werden. Obwohl die Indikationsgebiete des prophylaktischen Einsatzes bei Trauma und orthopädischen Eingriffen nicht spezifisch in der Fachinformation aufgeführt sind, ist die Anwendung unseres Erachtens nicht als Off Label Use zu bewerten.

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Early coagulation support protocol: A valid approach in real-life management of major trauma patients. Results from two Italian centres

Cited by 10 publications

References 42 publications

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Coagulopathy management of multiple injured patients – a comprehensive literature review of the European guideline 2019

Tranexamsäure zur Blutungsprophylaxe bei Trauma und orthopädischen Eingriffen – Standard oder individualisierte Anwendung?

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