Abstract
Coagulopathy in critically ill patients is common and of multifactorial origin [1]. Coagulopathy-associated risk of bleeding and the use of allogeneic blood products are independent risk factors for morbidity and mortality [2, 3]. Therefore, prompt and correct identification of the underlying causes of these coagulation abnormalities is required, since each coagulation abnormality necessitates very different therapeutic management strategies. Standard laboratory tests of blood coagulation yield only partial diagnostic information, and important coagulation defects, e.g., reduced clot stability, platelet dysfunction, or hyperfibrinolysis, remain undetected.
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References
Levi M, Opal SM (2006) Coagulation abnormalities in critically ill patients. Crit Care 10:222
Glance LG, Dick AW, Mukamel DB, et al (2011) Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 114:283–292
Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD (2007) Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116:2544–2552
Gorlinger K, Bergmann L, Dirkmann D (2012) Coagulation management in patients undergoing mechanical circulatory support. Best Pract Res Clin Anaesthesiol 26:179–198
Kozek-Langenecker S (2007) Management of massive operative blood loss. Minerva Anestesiol 73:401–415
Haas T, Spielmann N, Mauch J, et al (2012) Comparison of thromboelastometry (ROTEM(R)) with standard plasmatic coagulation testing in paediatric surgery. Br J Anaesth 108:36–41
Toulon P, Ozier Y, Ankri A, Fleron MH, Leroux G, Samama CM (2009) Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study. Thromb Haemost 101:394–401
Jambor C, von Pape KW, Spannagl M, Dietrich W, Giebl A, Weisser H (2011) Multiple electrode whole blood aggregometry, PFA-100, and in vivo bleeding time for the point-of-care assessment of aspirin-induced platelet dysfunction in the preoperative setting. Anesth Analg 113:31–39
Hartert H (1951) Thrombelastography, a method for physical analysis of blood coagulation. Z Gesamte Exp Med 117:189–203
Avidan MS, Alcock EL, Da Fonseca J, et al (2004) Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery. Br J Anaesth 92:178–186
Ak K, Isbir CS, Tetik S, et al (2009) Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study. J Card Surg 24:404–410
Westbrook AJ, Olsen J, Bailey M, Bates J, Scully M, Salamonsen RF (2009) Protocol based on thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study. Heart Lung Circ 18:277–288
Weber CF, Gorlinger K, Meininger D et al (2012) Point-of-care testing: A prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 117:531–547
Nuttall GA, Oliver WC, Santrach PJ et al (2001) Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 94:773–781
Gorlinger K, Dirkmann D, Hanke AA et al (2011) First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 115:1179–1191
Wang SC, Shieh JF, Chang KY et al (2010) Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. Transplant Proc 42:2590–2593
Gorlinger K (2006) Coagulation management during liver transplantation. Hamostaseologie 26:S64–S76
Gorlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA, Schochl H (2012) Reduction of fresh frozen plasma requirements by perioperative point-of-care coagulation management with early calculated goal-directed therapy. Transfus Med Hemother 39:104–113
Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ (2006) Guidelines on the management of massive blood loss. Br J Haematol 135:634–641
Sarani B, Dunkman WJ, Dean L, Sonnad S, Rohrbach JI, Gracias VH (2008) Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection. Crit Care Med 36:1114–1118
Watson GA, Sperry JL, Rosengart MR et al (2009) Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome. J Trauma 67:221–227
Maegele M, Lefering R, Yucel N et al (2007) Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury 38:298–304
Rourke C, Curry N, Khan S et al (2012) Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost 10:1342–1351
Holcomb JB, Minei KM, Scerbo ML et al (2012) Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. Ann Surg 256:476–486
Schochl H, Nienaber U, Hofer G et al (2010) Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care 14:R55
Afshari A, Wikkelso A, Brok J, Moller AM, Wetterslev J (2011) Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev CD007871
Adamzik M, Eggmann M, Frey UH et al (2010) Comparison of thromboelastometry with procalcitonin, interleukin 6, and C-reactive protein as diagnostic tests for severe sepsis in critically ill adults. Crit Care 14:R178
Adamzik M, Langemeier T, Frey UH et al (2011) Comparison of thrombelastometry with simplified acute physiology score II and sequential organ failure assessment scores for the prediction of 30-day survival: a cohort study. Shock 35:339–342
Spalding GJ, Hartrumpf M, Sierig T, Oesberg N, Kirschke CG, Albes JM (2007) Cost reduction of perioperative coagulation management in cardiac surgery: value of “bedside” thrombelastography (ROTEM). Eur J Cardiothorac Surg 31:1052–1057
Crowther MA, Warkentin TE (2008) Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 111:4871–4879
Hiippala ST, Myllyla GJ, Vahtera EM (1995) Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 81:360–365
Bolliger D, Gorlinger K, Tanaka KA (2010) Pathophysiology and treatment of coagulopathy in massive hemorrhage and hemodilution. Anesthesiology 113:1205–1219
Warmuth M, Mad P, Wild C (2012) Systematic review of the efficacy and safety of fibrinogen concentrate substitution in adults. Acta Anaesthesiol Scand 56:539–548
Dickneite G, Pragst I (2009) Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model. Br J Anaesth 102:345–354
Scharbert G, Kalb M, Marschalek C, Kozek-Langenecker SA (2006) The effects of test temperature and storage temperature on platelet aggregation: a whole blood in vitro study. Anesth Analg 102:1280–1284
Rinder CS, Mathew JP, Rinder HM, Bonan J, Ault KA, Smith BR (1991) Modulation of platelet surface adhesion receptors during cardiopulmonary bypass. Anesthesiology 75:563–570
Picker SM (2011) vitro assessment of platelet function. Transfus Apher Sci 44:305–319
Lethagen S (1994) Desmopressin (DDAVP) and hemostasis. Ann Hematol 69:173–180
Cauwenberghs S, van Pampus E, Curvers J, Akkerman JW, Heemskerk JW (2007) Hemostatic and signaling functions of transfused platelets. Transfus Med Rev 21:287–294
Korte W (2010) F. XIII in perioperative coagulation management. Best Pract Res Clin Anaesthesiol 24:85–93
Yank V, Tuohy CV, Logan AC et al (2011) Systematic review: benefits and harms of in-hospital use of recombinant factor VIIa for off-label indications. Ann Intern Med 154:529–540
Shander A, Van Aken H, Colomina MJ et al (2012) Patient blood management in Europe. Br J Anaesth 109:55–68
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Meybohm, P., Zacharowski, K., Weber, C.F. (2013). Point-of-Care Coagulation Management in Intensive Care Medicine. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2013. Annual Update in Intensive Care and Emergency Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35109-9_33
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DOI: https://doi.org/10.1007/978-3-642-35109-9_33
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