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

Abstract

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.

Pathological Background and Clinical Procedures in Oral Surgery Haemostasis Disorders: A Narrative Review

“…Theoretically, inhibition of TFP1 could ensure adequate thrombin generation by tissue factor, factor VIIa, and factor Xa in the early stages of the coagulation cascade. In this category of antibodies, we find Concizumab, for which a pro-coagulant dose-dependent effect has been noted, which lays the foundation for future studies on the use of the product in the treatment of haemophilia [64,65]. In the management of these therapies collaboration with the haematologist is important to establish which is the best therapy for the patient who needs to undergo surgery is important in the management of these therapies.…”

“…This therapy is based on plasma-derived products or synthesis products, called recombinants. [58][59][60][61][62][63][64][65].…”

“…To overcome the limitations, factor VIII lacking the B domain was made available to haemophilia A patients and is efficiently expressed in cultured cells by modification with genetic engineering techniques, leading to a longer half-life and lower immunogenicity. It was noted that, in some haemophilic patients, the replacement therapy with the deficient factor over time causes the production of antibodies against the inserted factor, which makes the therapy ineffective [64,65]. For this reason, products synthesized with recombinant DNA technology have been studied.…”

“…Tranexamic acid is an antifibrinolytic agent. It can be used as a systemic treatment with a dose of 20 mg/kg or as a rinse, being a good adjuvant in the control of bleeding [62][63][64][65].…”

“…Platelet transfusions: indicated when the disorder is severe (less than 30,000 platelets) and when other therapeutic measures have not been effective [62][63][64][65].…”