Modern Management of Bleeding, Clotting, and Coagulopathy in Trauma Patients: What Is the Role of Viscoelastic Assays?
Name
40719_2020_183_ReferencePDF.pdf
Size
1.32 MB
Format
Adobe PDF
Checksum (MD5)
05828ecc0c2e614e0a1461d5a064fabe
Author(s)
Dhara, Sanjeev
Moore, Ernest E
Yaffe, Michael B
Moore, Hunter B
Barrett, Christopher D
Date Issued
January 23, 2020
Publisher
Springer International Publishing
Version
Author's final manuscript
Abstract
Abstract
Purpose of Review
The purpose of this review is to briefly outline the current state of hemorrhage control and resuscitation in trauma patients with a specific focus on the role viscoelastic assays have in this complex management to include indications for use across all phases of care in the injured patient.
Recent Findings
Viscoelastic assay use to guide blood-product resuscitation in bleeding trauma patients can reduce mortality by up to 50%. Viscoelastic assays also reduce total blood products transfused, reduce ICU length of stay, and reduce costs. There are a large number of observational and retrospective studies evaluating viscoelastic assay use in the initial trauma resuscitation, but only one randomized control trial. There is a paucity of data evaluating use of viscoelastic assays in the operating room, post-operatively, and during ICU management in trauma patients, rendering their use in these settings extrapolative/speculative based on theory and data from other surgical disciplines and settings.
Summary
Both hypocoagulable and hypercoagulable states exist in trauma patients, and viscoelastic assays are better at diagnosing both relative to standard coagulation testing and can better indicate what therapy may be most appropriate. Further study is needed, particularly in the operating room and post-operative/ICU settings in trauma patients.
MIT Department
Koch Institute for Integrative Cancer Research at MIT
Center for Precision Cancer Medicine
Terms of Use
Creative Commons Attribution-Noncommercial-Share Alike
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1007/s40719-020-00183-w
