Intérêt de la thromboélastographie pour guider la correction de la coagulopathie post-traumatique : plus de MDS, moins de PSL ?

David, Jean-Stéphane; Imhoff, Etienne; Parat, S.; Augey, L.; Geay-Baillat, Marie-Odile; Incagnoli, Pascal; Tazarourte, Karim

doi:10.1016/j.tracli.2016.07.002

Cited by 7 publications

(2 citation statements)

References 54 publications

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“…A recent survey among surgeons and anaesthesiologists in Germany revealed that 90% used CCA to guide decision-making in the diagnosis and treatment of bleeding trauma patients, whereas 56% reported that they also used extended VEM such as ROTEM® or TEG® [555], and this predominantly in advanced trauma centres [556]. POC VEM may provide more rapid information about the underlying haemostatic deficiencies, including information on which part of the clotting process is disrupted, as well as on the dynamics of clot formation and lysis [557, 558], thereby allowing optimised and targeted coagulation therapy according to individual deficits, particularly with respect to the early use of coagulation factor concentrates (CFC) [544, 547, 559].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…Compared with the traditional coagulation function test, TEG can infuse the targeted blood products into the patients who are in the perioperative period, and accurately adjust the improved condition of blood coagulation in patient's body according to the quality of the blood transfusion to achieve the purpose of significantly improving the coagulation function of patient. TEG can comprehensively reflect the process, in which the blood clot forms and fiber dissolves in the sample blood, and reflect the interaction between clotting factors and platelets, which has a more accurate judgment for patient's overall coagulation condition (25). Moreover, the generation speed of TEG monitoring results are significantly faster than that of the traditional coagulation function test, which helps to instruct doctors to make timely decision and treatment for the blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Application value of thromboelastography in perioperative clinical blood transfusion and its effect on the outcome of patient

Shi

et al. 2019

Exp Ther Med

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Application value of thromboelastography (TEG) in perioperative clinical blood transfusion and its effect on the outcome of patient were investigated. Seventy-four patients, admitted to The Surgical Department of the First Hospital of Zibo from March 2015 to March 2018, were selected for this study. Among them, 34 patients took only the traditional coagulation function testing method as the blood transfusion guide during the perioperative period and they were regarded as the control group. The other 40 patients used TEG as the blood transfusion guide during the perioperative period, and they were regarded as the TEG group. The coagulation function indicators in 2 h before the operation and in 24 h after the operation, the transfusion amount and blood loss during the operation, the condition of the blood transfusion during the perioperative period, the occurrence rate of the postoperative rebleeding, the length of hospital stay and mortality of the patients in the two groups were compared. The coagulation function indicators of the patients in the two groups in 2 h before the operation and in 24 h after the operation showed that there was no significant difference between the two groups (P>0.050). However, APTT and Pt of the patients in the two groups both increased when compared with those before the treatment (P<0.050) and Hb, Hct, Plt and Fib all decreased (P<0.050). The suspended erythrocytes, Plt, fibrinogen and plasma in the TEG group were both significantly lower than those in the control group (P<0.001). Compared with the traditional coagulation function test, TEG was more accurate for estimating the coagulation function of patient and was more suitable for estimating the condition of blood transfusion of patient in the perioperative period; also, it could shorten the recovery period of patient and it is worthwhile to promote it in the clinic.

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Effects of modification of trauma bleeding management: A before and after study

Guth

Vassal

Friggeri

et al. 2019

Anaesthesia Critical Care & Pain Medicine

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Intérêt de la thromboélastographie pour guider la correction de la coagulopathie post-traumatique : plus de MDS, moins de PSL ?

Cited by 7 publications

References 54 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Application value of thromboelastography in perioperative clinical blood transfusion and its effect on the outcome of patient

Effects of modification of trauma bleeding management: A before and after study

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