10 de julho de 2013

Case Scenario: Management of Trauma-induced Coagulopathy in a Severe Blunt Trauma Patient

Jean-Stephane David, Anne Godier, Yesim Dargaud, Kenji Inaba

Anesthesiology 2013; 119:191-200, David et al.

Coagulopathy-related diffuse bleeding, which is complex and difficult to manage, is observed in around 20–30% of all severe trauma patients. Its management remains critical to patient survival; however, the optimal approach to treatment remains a matter of debate. Early recognition and adequate aggressive management of this Trauma-induced Coagulopathy (TIC) has been shown to substantially reduce mortality and improve outcomes in severely injured bleeding patients. To date, the use of fresh frozen plasma (FFP) is an integral part of massive transfusion protocols in most trauma centers and its early use has been advocated.

Moreover, the use of FFP is associated with well-established risks such as multiple organ failure or transfusion-related acute lung injury (TRALI), and there is insufficient evidence to guide the optimal use of this resource. To overcome these weaknesses, several European authors advocate the use of fibrinogen concentrates and/or prothrombin complex concentrates (PCC), with preliminary clinical studies suggesting an increased efficiency based on biological parameters and a reduction of mortality. Hence, recent European guidelines recommend the use of fibrinogen concentrates and suggest increasing the fibrinogen target level to 1.5–2.0 g/l. The purpose of this case scenario is to identify key points essential for the treatment of TIC.

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