Global Coagulation Testing in Acute Care Medicine: Back to Bedside?

Abstract

Objectives Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. Design As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. Conclusion The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management.

Damage Control Resuscitation und Damage Control Surgery

“…Viele Patienten stehen unter dem Einfluss von Antikoagulanzien und Thrombozytenaggregationshemmern, was bei der Therapie schwerer Blutungen berücksichtigt werden muss. Die Darstellung der Antagonisierung dieser Substanzen und der weiterführenden spezifischen Behandlung geht über den Fokus dieses Artikels hinaus und wurde an anderer Stelle detailliert zusammengefasst [18]. Grundsätzlich sollte ein isolierter Fokus auf die Optimierung der Hämostase nicht zu einer Vernachlässigung der Schocktherapie führen.…”

The Magic of Proteases: From a Procoagulant and Anticoagulant Factor V to an Equitable Treatment of Its Inherited Deficiency

“…Primary hemostasis [ 18 , 19 , 20 ] involves the formation of the white or platelet-rich thrombus. This process, mediated by platelets, the endothelium, and adhesion proteins, comprises activations, changes, and interactions between the different components of hemostasis.…”

Challenges in Coagulation Management in Neurosurgical Diseases: A Scoping Review, Development, and Implementation of Coagulation Management Strategies

“…Additionally, conventional laboratory tests can objectively evaluate the function of the coagulation system. In emergency situations where there is insufficient time for conventional laboratory testing, point-of-care tests offer a viable alternative [26]. If a disturbance of the blood coagulation at the time of surgery is detected, efforts should be made to investigate and optimize the cause(s) whenever possible, as intraoperative coagulation disorders are associated with postoperative complications and worse outcomes [1,2,4].…”