Key concepts in the management of difficult hemorrhagic cases.
Goals of hemorrhage management involve promoting coagulation and reducing fibrinolysis to enhance clot formation and stability, and minimizing hemorrhagic expansion to reduce the likelihood of adverse outcomes. The optimal hemostatic regimen to obtain these goals will differ according to the clinical scenario. Two hypothetical cases of patients with hemorrhage are presented that are typical of those encountered by clinical pharmacists who practice in centers that treat trauma or surgical patients or patients in need of emergency or critical care because of serious bleeding. To maximize therapy, the clinician must be aware of how best to clinically apply hemostatic agents, their comparative benefits and disadvantages, and the optimal methods for monitoring their effectiveness and toxicities.
MacLaren
Robert
R
Department of Clinical Pharmacy, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80262, USA. rob.maclaren@uchsc.edu
D000925:Anticoagulants / Q000009:adverse effects*; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000009:adverse effects / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000628:therapy; D003422:Critical Care; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005167:Factor VII / Q000009:adverse effects / Q000627:therapeutic use; D015942:Factor VIIa; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006487:Hemostasis; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D010949:Plasma; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D006490:Hemostatics; D011994:Recombinant Proteins; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa