TITLE

Coagulopathy: Its Pathophysiology and Treatment in the Injured Patient

AUTHOR(S)
Tieu, Brandon; Holcomb, John; Schreiber, Martin
PUB. DATE
May 2007
SOURCE
World Journal of Surgery;May2007, Vol. 31 Issue 5, p1055
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Hemorrhage continues to be one of the leading causes of death following trauma. Trauma patients are susceptible to the early development of coagulopathy and the most severely injured patients are coagulopathic on hospital admission. Hypothermia, acidosis, and dilution from standard resuscitation can worsen the presenting coagulopathy and perpetuate bleeding. Early identification of coagulopathy is dependent on clinical awareness and point of care laboratory values. Routinely used laboratory coagulation parameters fail to adequately describe this state. Thrombelastography is a test that can be done at the bedside and uses whole blood to provide a functional evaluation of coagulation. Rapid diagnosis of coagulopathy, followed by prevention or correction of hypothermia and acidosis should be a priority during the initial evaluation and resuscitation. Judicious use of resuscitation fluids and early replacement of coagulation factors will help prevent iatrogenic hemodilution. This review covers the pathophysiology as well as the clinical and laboratory diagnosis of coagulopathy. Prevention and treatment strategies are discussed, including early transfusion of coagulation factors during massive transfusion and the use of recombinant factor VIIa. Damage control resuscitation is briefly discussed, and it involves the combination of hypotensive resuscitation and hemostatic resuscitation. Finally, a description of the use of fresh whole blood in the military setting is included. Its use has been proven to be safe and beneficial in this setting and warrants further investigation as an adjunct to the management of civilian trauma patients.
ACCESSION #
24976637

 

Related Articles

  • Management of Trauma-Induced Coagulopathy: Trends and Practices. D'Angelo, Matthew R.; Dutton, Richard P. // AANA Journal;Feb2010, Vol. 78 Issue 1, p35 

    Nearly one-fourth of all trauma admissions present in varying degrees of coagulopathy. According to a US study, 40% of trauma fatalities are due to hemorrhage and hemorrhagic shock, and nearly all patients who are alive when they reach the hospital are coagulopathic when they die. Once...

  • Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in a patient with cardiomyopathy and hemophilia A. Thiagarajan, Ravi R.; Roth, Stephen J.; Margossian, Steven; Mackie, Andrew S.; Neufeld, Ellis J.; Laussen, Peter C.; Forbess, Joseph M.; Blume, Elizabeth D. // Intensive Care Medicine;Jun2003, Vol. 29 Issue 6, p985 

    Objective: To report the use of extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation in a patient with hemophilia A and dilated cardiomyopathy.Design: Case report.Interventions and Results: During ECMO factor VIII concentrate...

  • BLEEDING AND CLOTTING DISORDERS. Patton, Lauren L. // Burket's Oral Medicine, Diagnosis & Treatment;2008, p411 

    Chapter 17 of the book "Burket's Oral Medicine" is presented. It explores the epidemiology, pathophysiology and clinical and laboratory findings of bleeding and clotting disorders. It highlights the management of vessel wall disorders, platelet disorders and coagulation disorders. Congenital and...

  • Conservative treatment of concomitant extraperitoneal bladder rupture and intrabladder blood clot formation: Case report of application of ureteral catheterization. Chih-Yuan Fu; Chun-Han Shih; Po-Yen Chang; Chi-Hao Hsiao; Yu-Chun Wang; Ray-Jade Chen // Canadian Urological Association Journal;Dec2012, Vol. 6 Issue 6, pE256 

    Most extraperitoneal bladder ruptures can be treated conservatively with catheter drainage only. However, in patients with concomitant intrabladder blood clot formation and extraperitoneal bladder rupture, surgery for blood clot evacuation and bladder repair are usually needed due to occlusion...

  • Thromboelastography-Guided Transfusion Therapy in the Trauma Patient. Brazzel, Charice // AANA Journal;Apr2013, Vol. 81 Issue 2, p127 

    This article presents thromboelastography (TEG) as an important assay to incorporate into anesthesia practice for development of evidence-based therapy of trauma patients receiving blood transfusions. The leading cause of death worldwide results from trauma. Hemorrhage is responsible for 30% to...

  • Life-threatening hemorrhage in neonates: management with recombinant activated factor VII. Veldman, Alex; Fischer, Doris; Voigt, Burkhard; Beyer, Peter A.; Schlösser, Rolf; Allendorf, Antje; Kreuz, Wolfhardt // Intensive Care Medicine;Nov2002, Vol. 28 Issue 11, p1635 

    Objective. Massive hemorrhage with shock is a common problem for the intensivist. The use of recombinant activated factor VII (rFVIIa), known as efficient treatment for hemophilia, has been reported to control severe bleeding episodes in critically care patients, but never in preterm neonates....

  • Subgaleal hemorrhage in a neonate with factor X deficiency following a non-traumatic cesarean section. Wetzel, E A; Kingma, P S // Journal of Perinatology;Apr2012, Vol. 32 Issue 4, p304 

    This case report describes a term infant born by a non-traumatic, non-instrumented cesarean section that presented with respiratory failure and severe metabolic acidosis secondary to subgaleal hemorrhage (SGH). Further evaluation revealed a functional factor X deficiency that was initially...

  • Unexpected laboratory diagnosis: Acquired dysfibrinogenemia in a bleeding patient with liver disease. Math, Santosh K. S.; Sanders, Mary Ann; Hollensead, Sandra C. // MLO: Medical Laboratory Observer;Oct2010, Vol. 42 Issue 10, p30 

    The article presents a case study of a 49-year-old African-American female with a history of hepatitis C and hypertension who was examined for a possible dysfibrinogenemia when an abnormal thrombin time (TT) and reptilase time (RT) were reported by the laboratory. Screening coagulation assays...

  • A rare but important adverse event associated with adult voluntary medical male circumcision: prolonged bleeding. Galukande, Moses; Kahendehe, Carol; Buuza, Eria; Sekavuga, Denis Bbaale // International Journal of Emergency Medicine;2015, Vol. 8 Issue 1, p1 

    Background: The majority of bleeding disorders worldwide are undiagnosed. Their moderate or severe forms are associated with considerable morbidity and mortality. In the advent of mass male circumcision for the partial prevention of HIV, undiagnosed and diagnosed cases of bleeding disorders are...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics