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Rational and Timely Use of Coagulation Factor Concentrates in Massive Bleeding Without Point-of-Care Coagulation Monitoring

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Annual Update in Intensive Care and Emergency Medicine 2015

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2015 ((AUICEM,volume 2015))

Abstract

In this chapter, we describe our approach to emergency hemostatic management in severely bleeding patients when diagnostic information from point-of-care coagulation monitoring (thromboelastometry [ROTEM], thrombelastography [TEG]) is unavailable. We firmly believe that ROTEM/TEG-guided algorithms for hemostatic treatment represent the optimal approach, consistent with their inclusion in recent guidelines [1, 2], as coagulation diagnostics with these devices offer a number of advantages over conventional laboratory based coagulation tests [3]. However, where ROTEM/TEG measurements are not unavailable, which remains the reality in many emergency/operating rooms, it is imperative that a rational and timely strategy exists for effective hemostatic therapy in order to avoid detrimental outcomes. Here, we outline a stepwise approach that could be considered for this purpose (Fig. 1). We do not offer recommendations, guidance, or a systematic review of the literature, but instead aim to start debate about improving care for the massively bleeding patient in urgent need of effective hemostatic therapy when bedside monitoring is not possible.

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Authors and Affiliations

  1. Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany

    O. Grottke & R. Rossaint

  2. Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland

    D. R. Spahn

Authors
  1. O. Grottke
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  2. D. R. Spahn
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  3. R. Rossaint
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Corresponding author

Correspondence to O. Grottke .

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Editors and Affiliations

  1. Université libre de Bruxelles, Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent Prof.

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Grottke, O., Spahn, D.R., Rossaint, R. (2015). Rational and Timely Use of Coagulation Factor Concentrates in Massive Bleeding Without Point-of-Care Coagulation Monitoring. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_34

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  • DOI: https://doi.org/10.1007/978-3-319-13761-2_34

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13760-5

  • Online ISBN: 978-3-319-13761-2

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