Time for changing coagulation management in trauma-related massive bleeding

@article{Fries2009TimeFC,
  title={Time for changing coagulation management in trauma-related massive bleeding},
  author={Dietmar R Fries and Petra Innerhofer and Wolfgang Schobersberger},
  journal={Current Opinion in Anaesthesiology},
  year={2009},
  volume={22},
  pages={267–274}
}
Purpose of review New insights into the pathophysiology of trauma-induced coagulopathy, the increasing availability of point-of-care devices and awareness of side effects of intravenous fluids and traditional fresh frozen plasma therapy has encouraged new concepts for managing massive blood loss. Recent findings Trauma-induced coagulopathy primarily results from blood loss, hypovolemia-induced activation of the protein C system and consequent increase of the fibrinolytic potential, whereas… 
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TLDR
Patients with uncontrolled bleeding, regardless of it´s cause, should be treated with hemostatic control resuscitation involving early administration of plasma and platelets and earliest possible goal-directed therapy, based on the results of TEG/ROTEM analysis.
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TLDR
Patients with uncontrolled bleeding, regardless of its cause, should be treated with goal‐directed haemostatic control resuscitation involving the early administration of plasma and platelets and based on the results of the TEG/ROTEM analysis.
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TLDR
Plasma-based routine coagulation tests, like prothrombin time and activated partial thromboplastin time, are inappropriate for monitoring coagulopathy and guide therapy in trauma patients and viscoelastic haemostatic assays (VHAs) such as thrombelastography and rotation thromboelastometry should be used.
Anticoagulation, Resuscitation, and Hemostasis
TLDR
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Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence?
TLDR
There is actually no sound evidence from well-designed studies that confirm the usefulness of SLTs for diagnosis of coagulopathy or to guide haemostatic therapy, and no data from randomized controlled trials support the use ofSLTs.
Management of major trauma haemorrhage: treatment priorities and controversies
TLDR
Evidence for the clinical application of TEG and ROTEM in trauma is emerging with a number of studies evaluating their ability to diagnose coagulopathy early and facilitate goal‐directed transfusion.
Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM®)-guided administration of fibrinogen concentrate and prothrombin complex concentrate
TLDR
ROTEM®-guided haemostatic therapy, with fibrinogen concentrate as first-line haemOSTatic therapy and additional PCC, was goal-directed and fast, and a favourable survival rate was observed.
Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial.
TLDR
The results underline the importance of early and effective fibrinogen supplementation for severe clotting failure in multiple trauma and make some conclusions that first-line CFC is superior to FFP.
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