Targeted coagulation management in severe trauma: the controversies and the evidence

Winearls, James, Reade, Michael, Miles, Helen, Bulmer, Andrew, Campbell, Don, Goerlinger, Klaus and Fraser, John F. (2016) Targeted coagulation management in severe trauma: the controversies and the evidence. Anesthesia and Analgesia, 123 4: 910-924. doi:10.1213/ANE.0000000000001516

Author Winearls, James
Reade, Michael
Miles, Helen
Bulmer, Andrew
Campbell, Don
Goerlinger, Klaus
Fraser, John F.
Title Targeted coagulation management in severe trauma: the controversies and the evidence
Journal name Anesthesia and Analgesia   Check publisher's open access policy
ISSN 1526-7598
Publication date 2016-10-01
Year available 2016
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1213/ANE.0000000000001516
Open Access Status Not yet assessed
Volume 123
Issue 4
Start page 910
End page 924
Total pages 15
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 2703 Anesthesiology and Pain Medicine
Abstract Hemorrhage in the setting of severe trauma is a leading cause of death worldwide. The pathophysiology of hemorrhage and coagulopathy in severe trauma is complex and remains poorly understood. Most clinicians currently treating trauma patients acknowledge the presence of a coagulopathy unique to trauma patients - trauma-induced coagulopathy (TIC) - independently associated with increased mortality. The complexity and incomplete understanding of TIC has resulted in significant controversy regarding optimum management. Although the majority of trauma centers utilize fixed-ratio massive transfusion protocols in severe traumatic hemorrhage, a widely accepted "ideal" transfusion ratio of blood to blood products remains elusive. The recent use of viscoelastic hemostatic assays (VHAs) to guide blood product replacement has further provoked debate as to the optimum transfusion strategy. The use of VHA to quantify the functional contributions of individual components of the coagulation system may permit targeted treatment of TIC but remains controversial and is unlikely to demonstrate a mortality benefit in light of the heterogeneity of the trauma population. Thus, VHA-guided algorithms as an alternative to fixed product ratios in trauma are not universally accepted, and a hybrid strategy starting with fixed-ratio transfusion and incorporating VHA data as they become available is favored by some institutions. We review the current evidence for the management of coagulopathy in trauma, the rationale behind the use of targeted and fixed-ratio approaches and explore future directions.
Keyword Anesthesiology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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