Interventional Algorithms for the Control of Coagulopathic Bleeding in Surgical, Trauma, and Postpartum Settings

Abstract

Several clinical settings are associated with specific coagulopathies that predispose to uncontrolled bleeding. With the growing concern about the need for optimizing transfusion practices and improving treatment of the bleeding patient, a group of 9 Portuguese specialists (Share Network Group) was created to discuss and develop algorithms for the clinical evaluation and control of coagulopathic bleeding in the following perioperative clinical settings: surgery, trauma, and postpartum hemorrhage. The 3 algorithms developed by the group were presented at the VIII National Congress of the Associação Portuguesa de Imuno-hemoterapia in October 2013. They aim to provide a structured approach for clinicians to rapidly diagnose the status of coagulopathy in order to achieve an earlier and more effective bleeding control, reduce transfusion requirements, and improve patient outcomes. The group highlights the importance of communication between different specialties involved in the care of bleeding patients in order to achieve better results.

What is the evidence for platelet transfusion in perioperative settings?

“…Due to the potential adverse events and costs associated with platelet transfusion, it may be advisable to consider alternative treatments for coagulopathic perioperative patients. Targeted algorithms to treat bleeding recommend the administration of specific haemostatic agents, such as fibrinogen supplementation with cryoprecipitate or fibrinogen concentrate, prothrombin complex concentrate, Factor XIII or FVII, as well as allogeneic blood products . Based on studies utilizing these algorithms, guidelines for the management of severe perioperative bleeding recommend the use of transfusion algorithms incorporating predefined intervention triggers to guide haemostatic intervention, as these may reduce transfusion requirements, improve outcomes and lower costs .…”

Interventional Algorithm in Gastrointestinal Bleeding—An Expert Consensus Multimodal Approach Based on a Multidisciplinary Team

“…Factor XIII supplementation is recommended by several updated guidelines 5,49 and also included in coagulation support algorithms for bleeding patients with functional FXIII deficiency, alongside with fibrinogen and PCC administration under VET analysis. 36,40,43 Recent guidelines state that "in Mortality rate: 10-20% at 6 weeks ** Early TIPS within 72 h (ideally <24 h) consider if bleeding from EV, GOV1 and GOV2 at high risk of treatment failure (e.g. cases of ongoing or diffuse bleeding and low clot strength despite adequate fibrinogen concentrate, it is likely that FXIII activity is critically reduced" and "in cases of significant FXIII deficiency (eg.<30 to <60% activity), FXIII concentrate (30IU/Kg) can be administered (Grade 2C).…”

“…-TP/INR or aPTT >1.5 x normal and acute/acƟve bleeding [4][5][6]10,35,39,43 + acute liver failure (ALF) (Grade 2C) 10,48 , LD 10,46,47 -Volume blood loss: ≥ 150-200% (≥1.5 TBV) 5,43 < 100% (<1.0 TBV) in liver disease 46 -ROTEM:…”

Severe Postpartum Coagulopathy Without Haemorrhage: A Case Report

“…3 Most often linked with high morbidity and mortality rates, PPH demands prevention, prompt diagnosis and effective management. 4 PPH can be due to uterine atony, retained placental tissue, trauma or coagulation disorders. 3 According to aetiology, PPH severity differs.…”