Management of Coagulopathy in Bleeding Patients

Abstract

Early recognition of coagulopathy is necessary for its prompt correction and successful management. Novel approaches, such as point-of-care testing (POC) and administration of coagulation factor concentrates (CFCs), aim to tailor the haemostatic therapy to each patient and thus reduce the risks of over- or under-transfusion. CFCs are an effective alternative to ratio-based transfusion therapies for the correction of different types of coagulopathies. In case of major bleeding or urgent surgery in patients treated with vitamin K antagonist anticoagulants, prothrombin complex concentrate (PCC) can effectively reverse the effects of the anticoagulant drug. Evidence for PCC effectiveness in the treatment of direct oral anticoagulants-associated bleeding is also increasing and PCC is recommended in guidelines as an alternative to specific reversal agents. In trauma-induced coagulopathy, fibrinogen concentrate is the preferred first-line treatment for hypofibrinogenaemia. Goal-directed coagulation management algorithms based on POC results provide guidance on how to adjust the treatment to the needs of the patient. When POC is not available, concentrate-based management can be guided by other parameters, such as blood gas analysis, thus providing an important alternative. Overall, tailored haemostatic therapies offer a more targeted approach to increase the concentration of coagulation factors in bleeding patients than traditional transfusion protocols.

Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service

“…For haemorrhaging patients in extremis to survive, they should have access to modern haemorrhage control treatments available in trauma hospitals as well as balanced blood transfusions [10,25]. Tailored treatment offering out of hospital whole blood to patients with lifethreatening noncompressible haemorrhage may offer a more targeted approach than traditional transfusion protocols [9,26]. The decision to initiate transfusion in a patient with suspected haemorrhagic shock is both complex and time-critical and is based on a variety of symptoms, clinical presentations and mechanisms of injury.…”

Correcting Coagulopathy for Image-Guided Procedures

“…Urgent or emergent situations require correction with vitamin K, fresh frozen plasma (FFP), and prothrombin complex concentrate (PCC). 14 15…”

“…Urgent or emergent situations require correction with vitamin K, fresh frozen plasma (FFP), and prothrombin complex concentrate (PCC). 14,15 Vitamin K Vitamin K can be administered as an oral, subcutaneous, or IV dose. The desired clinical effect usually occurs within 6 to 8 hours after administering an IV dose of 5 to 10 mg.…”

O papel do concentrado de complexo protrombrínico no manejo da coagulopatia induzida por trauma: uma revisão integrativa

“…A avaliação da coagulopatia e o controle do sangramento são frequentemente guiados por testes laboratoriais convencionais, incluindo TP, INR, TTPa e teste de fibrinogênio de Clauss. No entanto, a utilidade dos ensaios laboratoriais convencionais na avaliação ou tratamento da coagulopatia tem sido questionada, pois eles fornecem informações limitadas como, tempo de coagulação e contagem de plaquetas, são demorados e tendem a ser omitidos em situações em que é necessário um tratamento rápido, como em sangramento grave (Haas et al, 2015;Hofer et al, 2022). Em contraste, os testes viscoelásticos como a tromboelastometria e tromboelastografia, podem ser usados como testes de monitoramento no local de atendimento e fornecem informações em tempo real sobre as propriedades mecânicas da formação do coágulo, além de informações dinâmicas sobre a velocidade do início da coagulação, cinética do crescimento, firmeza e dissolução dos coágulos (Gonzalez et al, 2016).…”