[Perioperative coagulation management controlled by thrombelastography. Clinical implementation illustrated by reference to a case of acquired coagulopathy following aortic stab injury].
Uncontrolled bleeding is one of the main reasons for a lethal outcome of severe trauma. Loss, consumption and dilution of clotting factors and platelets induce a complex acquired coagulopathy. Beside surgical control of bleeding, early and precise coagulation therapy is essential for successful treatment. We report on a patient whose life-threatening bleeding and perioperative coagulopathy after a knife injury to the aorta was successfully treated by surgical control of the bleeding and subsequent targeted coagulation therapy with factor concentrates and fresh-frozen plasma. The coagulopathy was diagnosed and managed by means of bed-side thrombelastography.
Grashey
R
R
Klinik für Anaesthesiologie, Ludwig Maximilians Universität München, Nussbaumstrasse 20, 80336 Munich. bernhard.heindl@med.uni-muenchen.de
Mathonia
P
P
Mutschler
W
W
Heindl
B
B
D000328:Adult; D000347:Afibrinogenemia / Q000097:blood / Q000628:therapy; D001012:Aorta, Abdominal / Q000293:injuries* / Q000601:surgery; D001780:Blood Coagulation Tests; D019917:Blood Vessel Prosthesis Implantation; D003106:Colon / Q000293:injuries / Q000601:surgery; D003131:Combined Modality Therapy; D003422:Critical Care; D017707:Erythrocyte Transfusion; D005440:Fluid Therapy; D006465:Hemoperitoneum / Q000601:surgery*; D006474:Hemorrhagic Disorders / Q000097:blood / Q000628:therapy; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood / Q000628:therapy; D008297:Male; D008638:Mesenteric Arteries / Q000293:injuries / Q000601:surgery; D010949:Plasma; D010976:Platelet Count; D017713:Platelet Transfusion; D012086:Reoperation; D013536:Suture Techniques; D013916:Thrombelastography; D014951:Wounds, Stab / Q000601:surgery*