Hemostatic defects in massive transfusion: an update and treatment recommendations.

Hemostatic defects in massive transfusion: an update and treatment recommendations. Expert Rev Hematol. 2020 Dec 03;: Authors: Napolitano LM Abstract INTRODUCTION: Acute hemorrhage is a global healthcare issue, and remains the leading preventable cause of death in trauma. Acute severe hemorrhage can be related to traumatic, peripartum, gastrointestinal, and procedural causes. Hemostatic defects occur early in patients requiring massive transfusion. Early recognition and treatment of hemorrhage and hemostatic defects are required to save lives and to achieve optimal patient outcomes. AREAS COVERED: This review discusses current evidence and trials aimed at identifying the optimal treatment for hemostatic defects in hemorrhage and massive transfusion. Literature search included PubMed and Embase. EXPERT OPINION: Patients with acute hemorrhage requiring massive transfusion commonly develop coagulopathy due to specific hemostatic defects, and accurate diagnosis and prompt correction are required for definitive hemorrhage control. Damage control resuscitation and massive transfusion protocols are optimal initial treatment strategies, followed by goal-directed individualized resuscitation using real-time coagulation monitoring. Distinct phenotypes exist in trauma-induced coagulopathy, including "Bleeding" or "Thrombotic" phenotypes, and hyperfibrinolysis vs. fibrinolysis shutdown. The trauma "lethal triad" (hypothermia, coa...
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research