HHE Sponsored supplement: Managing perioperative bleed - Page 5

that point-of-care and factor concentrate-based coagulation algorithms result in reduced: • need for allogeneic blood products 10-16 • mortality 10,12 • incidence of acute kidney injury 13,14 • costs 10,11,17 • re-exploration rate 13 and • length of stay. 11 These benefits have been demonstrated in major trauma, 12,17 cardiac surgery, 10,11,13,14,17 paediatric surgery, 16 and post-partum haemorrhage. 15 The case therefore is clear. We are to introduce point-of-care and factor concentrate-based coagulation algorithms in the management of bleeding and haemostasis. However, creating such algorithms is not sufficient. We need to implement them and provide training in interdisciplinary situations, and monitor algorithm compliance to ensure that the patients benefit from the most advanced bleeding treatment concepts. 5 HHE 2018 | hospitalhealthcare.com Early monitoring of coagulation defects at the bedside is key for a successful specific treatment References 1 Ranucci M et al. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thoracic Surg 2013;96(2):478–85. 2 Frith D et al. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations. J Thromb Haemost 2010;8(9):1919–25. 3 Rossaint R et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016, 20(1):100. 4 Shapiro MB et al. Damage control: collective review. J Trauma 2000;49(5):969–78. 5 Mannucci PM. Treatment of von Willebrand’s Disease. N Engl J Med 2004; 351(7):683–94. 6 Collins PW et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood 2014; 124(11):1727–36. 7 Collins PW et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth 2017;119(3):411–21. 8 Dirkmann D et al. Early thromboelastometric variables reliably predict maximum clot firmness in patients undergoing cardiac surgery: a step towards earlier decision making. Acta Anaesthesiologica Scandinavica 2013; 57(5):594–603. 9 Ganter MT, Hofer CK.Coagulation monitoring: Current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth analg 2008; 106(5):1366–75. 10 Weber CF et al. Point-of- care testing: A prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012; 117(3):531–47. 11 Pearse BL et al. Protocol guided bleeding management improves cardiac surgery patient outcomes. Vox Sang 2015;109(3):267–79. 12 Stein P et al. Change of transfusion and treatment paradigm in major trauma patients. Anaesthesia 2017;72(11):1317–26. 13 Deppe AC et al. Point-of- care thromboelastography/ thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res 2016;203(2):424–33. 14 Serraino GF, Murphy GJ. Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis. Br J Anaesth 2017;118(6):823–33. 15 Mallaiah S et al. Introduction of an algorithm for ROTEM- guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia 2015;70(2):166–75. 16 Haas T et al. Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial. Br J Anaesthes 2015;115(2):234–43. 17 Whiting P et al. Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis. Health Tech Assess 2015;19(58):1–228.