[Perioperative coagulation management in multiple trauma patients based on viscoelastic test results]. / Gerinnungsmanagement bei Polytrauma mit Hilfe viskoelastischer Tests.
Unfallchirurg
; 117(2): 111-7, 2014 Feb.
Article
em De
| MEDLINE
| ID: mdl-24482057
ABSTRACT
Exsanguination represents the most common and potentially preventable cause of death in major trauma patients. Rapid surgical intervention coupled with an early and aggressive hemostatic therapy not only results in survival benefits of coagulopathic trauma patients, but also reduces the incidence of complications and costs. Standard coagulation tests are not suitable to adequately characterize the complexity of trauma-induced coagulopathy (TIC). This fact has led to a renaissance of viscoelastic tests, such as rotational thromboelastometry (ROTEM®) and thrombelastography (TEG®), which can be used as point-of-care monitors. In some trauma centers treatment algorithms have been developed, where hemostatic therapy is based on viscoelastic test results. Shock and tissue trauma activate profibrinolytic pathways which in turn result in premature dissolution of formed clots. Tranexamic acid rapidly and inexpensively blocks hyperfibrinolysis. ROTEM®/TEG® measurements revealed that diminished clot strength is associated with an increased bleeding tendency. Depending on the underlying cause, administration of fibrinogen concentrate and/or platelet concentrate administration improves clot firmness. Thrombin generation is initially less compromised and can be improved by the administration of plasma, prothrombin complex concentrate, or with restrictiveness by recombinant activated factor VII.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pré-Medicação
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Tromboelastografia
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Traumatismo Múltiplo
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Hemostáticos
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Hemorragia
Tipo de estudo:
Etiology_studies
Limite:
Humans
Idioma:
De
Ano de publicação:
2014
Tipo de documento:
Article