Transfusion strategy in multiple trauma patients

Theusinger, Oliver M.; Stein, Philipp; Spahn, Donat R.

doi:10.1097/mcc.0000000000000152

Cited by 25 publications

(16 citation statements)

References 102 publications

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“…The third example to be mentioned is the algorithm published by Theusinger et al [60,61]. This algorithm also takes into consideration different laboratory and POC results, such as ROTEM, CoaguCheck and Multiplate, and gives clear treatment orders.…”

Section: Algorithms Usedmentioning

confidence: 99%

Point of Care and Factor Concentrate-Based Coagulation Algorithms

Theusinger

Stein

Levy

2015

Transfus Med Hemother

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In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving.

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Section: Algorithms Usedmentioning

confidence: 99%

Point of Care and Factor Concentrate-Based Coagulation Algorithms

Theusinger

Stein

Levy

2015

Transfus Med Hemother

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“…4 ). The ROTEM has an equivalent test to MAFF called FIBTEM which uses cytochalsin D to inhibit platelets rather than abciximab [70, 71]. Darlington and colleagues showed correlation of platelet count, α angle and Clauss fibrinogen concentration [72].…”

Section: Trauma Induced Coagulopathy and Acquired Coagulopathymentioning

confidence: 99%

“…In the United States as opposed to Europe, the TEG without platelet mapping and without functional fibrinogen is the most common VET used to determine POC clot integrity. As a result, published guidelines in the United States utilize the α angle as a temporary bedside surrogate for evaluating the need for fibrinogen replacement [19, 22, 46-48, 70, 71, 76-78]. Solomon et al have most recently clarified the best test for assessing the need for fibrinogen and platelets.…”

Section: Trauma Induced Coagulopathy and Acquired Coagulopathymentioning

confidence: 99%

Targeted Thromboelastographic (TEG) Blood Component and Pharmacologic Hemostatic Therapy in Traumatic and Acquired Coagulopathy

Walsh

Fritz²,

Hake³

et al. 2016

CDT

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Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation. This review describes the utility of VETs, in particular, TEG, to provide TTHAT in trauma and acquired non-trauma-induced coagulopathy.Keywords: Thromboelastography, point-of-care, acquired coagulopathy, blood component therapy, systemic hemostatic agents, trauma-induced coagulopathy, hemostatic resuscitation, tranexamic acid, targeted pharmacologic therapy. TRAUMA INDUCED COAGULOPATHY AND AC-QUIRED COAGULOPATHY IntroductionCoagulopathy is found in approximately 25% of severely injured trauma patients on admission to the emergency department (ED). Patients with Trauma-Induced Coagulopathy (TIC) are at a higher risk for increased transfusion requirements and death compared to those without TIC [1][2][3][4][5]. The etiology of TIC has been a matter of speculation. Trauma induced disturbances of compensatory activation of activated protein C (APC), hypofibrinogenemia, Tissue Factor (TF) release, coagulation factor consumption and dilution, platelet dysfunction, and fibrinolysis have been cited as possible causes of TIC [1][2][3][4][5][6][7][8][9]. In addition, it has been argued by Gando and others that TIC is a variant of disseminated intravascular coagulation [10,11]. Most recently, Dobson et al. have described the etiology of TIC in relation to four paradigms of hemostatic derangement which are: 1) the DIC/ consumption/ fibrinolysis hypothesis 2) the activated protein-C hypothesis 3) the glycocalyx hypothesis and 4) the "fibrinogencentric" hypothesis. These hypotheses are not mutually exclusive. It is necessary to refer to this theoretical aspect of

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“…Similarly Theusinger and coworkers propose to decide on RBC, FFP and platelet transfusion on a case-per-case basis rather than on a specific medical laboratory profile issued as transfusion trigger [42], an approach bearing biologic variation in mind. Decision-making for supporting measures, e.g.…”

Section: Critical Appraisal Of Transfusion Trigger Cutoffs Set By Larmentioning

confidence: 99%