Applying the Cell-Based Coagulation Model in the Management of Critical Bleeding

Abstract

The cell-based coagulation model was proposed 15 years ago, yet has not been applied commonly in the management of critical bleeding. Nevertheless, this alternative model may better explain the physiological basis of current coagulation management during critical bleeding. In this article we describe the limitations of the traditional coagulation protein cascade and standard coagulation tests, and explain the potential advantages of applying the cell-based model in current coagulation management strategies. The cell-based coagulation model builds on the traditional coagulation model and explains many recent clinical observations and research findings related to critical bleeding unexplained by the traditional model, including the encouraging results of using empirical 1:1:1 fresh frozen plasma:platelets:red blood cells transfusion strategy, and the use of viscoelastic and platelet function tests in patients with critical bleeding. From a practical perspective, applying the cellbased coagulation model also explains why new direct oral anticoagulants are effective systemic anticoagulants even without affecting activated partial thromboplastin time or the International Normalized Ratio in a dose-related fashion. The cell-based coagulation model represents the most cohesive scientific framework on which we can understand and manage coagulation during critical bleeding.

Use of viscoelastic tests to predict clinical thromboembolic events: A systematic review and meta‐analysis

“…With this caveat in mind, viscoelastic tests can be considered as a useful adjunct to clinical judgment to stratify a patient's risk of developing thromboembolism, in addition to its more established role of guiding blood product transfusion in critical bleeding. 14,63 F I G U R E 4 The funnel plot, with the regression line in dashed line (P = .879), shows no obvious publication bias. ESS, effective sample size.…”

“…First, evidence suggests that whole-blood viscoelastic tests have the potential to inform the clinicians about the mechanisms of bleeding over and above the information provided by standard coagulation blood tests. 14,63 Because a viscoelastic test assesses the clotting process of whole blood, including platelets, it has a potential to reflect bleeding or thrombotic tendency that is not measurable by activated partial thromboplastin time or prothrombin time, as both tests only use platelet-poor plasma. 63 Our results suggested that a viscoelastic hypercoagulable state is associated with an increased risk of thromboembolism, a 3.6-fold higher odd, compared to those without a hypercoagulable state.…”

“…14,63 Because a viscoelastic test assesses the clotting process of whole blood, including platelets, it has a potential to reflect bleeding or thrombotic tendency that is not measurable by activated partial thromboplastin time or prothrombin time, as both tests only use platelet-poor plasma. 63 Our results suggested that a viscoelastic hypercoagulable state is associated with an increased risk of thromboembolism, a 3.6-fold higher odd, compared to those without a hypercoagulable state. And as this was a diagnostic odds ratio, it would not be affected by the prevalence of the thromboembolism.…”

Conceptos básicos para la solicitud e interpretación de analíticas en Podología.

“…La cascada de coagulación de manera tradicional se explica en base a dos vías: la intrínseca y la extrínseca; ambas confluyen en una vía común. En la actualidad se ha puesto en entredicho el modelo clásico de la coagulación, apareciendo el llamado "modelo celular" 71 , en el que cobra importancia considerar a las propias células como elementos esenciales en el proceso de coagulación.…”

Detailed assessment of benefits and risks of retrievable inferior vena cava filters on patients with complicated injuries: the da Vinci multicentre randomised controlled trial study protocol

“…Even though many patients with major trauma will have deranged coagulation profiles which are considered as contraindicated to receive anticoagulant prophylaxis, their propensity to develop VTE does not appear to be different from those without such acquired coagulopathy. [59][60][61] This group of patients with trauma will serve as the best candidates to assess the cost-effectiveness of IVC filters and will form the study population of this planned RCT in which we will adopt a proactive approach to detect VTE in our study patients (for details see below).…”