Open AccessManagement of Postinjury Coagulopathy
Author(s) -
Zimrin Ann B.,
Dutton Richard P.,
McCunn Maureen,
Hess John R.
Publication year - 2005
Publication title -
transfusion alternatives in transfusion medicine
Language(s) - English
Resource type - Journals
eISSN - 1778-428X
pISSN - 1295-9022
DOI - 10.1111/j.1778-428x.2005.tb00131.x
Subject(s) - medicine , coagulopathy , hypothermia , recombinant factor viia , resuscitation , hematocrit , anesthesia , thromboelastography , coagulation , damage control surgery , clotting factor , activated clotting time , hemostasis , platelet , disseminated intravascular coagulation , hypovolemia , surgery , cardiopulmonary bypass
SUMMARY Coagulopathy is commonly seen in seriously injured patients and can make control of hemorrhage more difficult. An observed defect in blood clotting may be preexisting, due to severe injury, a result of delayed treatment, or exacerbated by resuscitation efforts. Factors that promote coagulopathy include hypothermia, acidosis, intravascular consumption and extravascular loss of coagulation factors and platelets, reduced platelet effectiveness secondary to low hematocrit, interactions of coagulation proteins and platelets with volume expanders, and the hemodilution associated with massive transfusion. Management of the hemorrhagic diathesis involves treatment of hypothermia, avoidance of excessive colloid and crystalloid volume in the resuscitation effort, damage‐control surgery, appropriate use of blood products and, in selected cases, the use of tissue sealants and recombinant factor VIIa.