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Pathophysiology and treatment of coagulopathy in massive hemorrhage and hemodilution

Bolliger, Daniel and Görlinger, Klaus and Tanaka, Kenichi A.. (2010) Pathophysiology and treatment of coagulopathy in massive hemorrhage and hemodilution. Anesthesiology, Vol. 113, H. 5. pp. 1205-1219.

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Official URL: http://edoc.unibas.ch/dok/A6007245

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Abstract

Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder. Reduced thrombin activation is partially compensated by lower inhibitory activities of antithrombin and other protease inhibitors, whereas plasma fibrinogen is rapidly decreased proportional to the extent of hemodilution. Adequate fibrinogen levels are essential in managing dilutional coagulopathy. After extensive hemodilution, fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased.Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies. Purified factor concentrates of plasma origin and from recombinant synthesis are increasingly used for a rapid restoration of targeted factors. Future clinical studies are necessary to establish the specific indication, dosing, and safety of novel hemostatic interventions.
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Ehemalige Einheiten Querschnittsfächer (Klinik) > Allgemeine Anästhesie (Scheidegger)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Ehemalige Einheiten Querschnittsfächer (Klinik) > Allgemeine Anästhesie (Scheidegger)
UniBasel Contributors:Bolliger, Daniel
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Bibsysno:Link to catalogue
Publisher:American Society of Anesthesiologists
ISSN:0003-3022
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:19 Jul 2013 07:44
Deposited On:19 Jul 2013 07:41

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