Transfusion strategies in postinjury coagulopathy.
OBJECTIVE
Coagulopathy represents one of the major challenges in the management of the severely injured patient. The present review will attempt to define the current 'optimal' transfusion strategies for the coagulopathic trauma patient and to assess potential weaknesses in the pertinent literature.


RESULTS
Existing limitations in the management of postinjury coagulopathy include the lack of a uniform definition of the entity, the lack of understanding the mechanisms, and the lack of accurate and rapid diagnostic tests. Rapid thromboelastography represents an improved diagnostic modality that allows 'point-of-care' testing of postinjury coagulopathy and monitoring of transfusion strategies. Ongoing controversies in the field include the optimal target blood pressure and the ideal threshold for blood component transfusions in the hospital. Furthermore, the concentration of plasma transfusions remains an ongoing debate.


CONCLUSIONS
Coagulopathy has a significant impact on survival after major trauma. Most recent publications in the field are of retrospective design, and thus do not allow definitive recommendations for clinical practice. Well designed prospective trials and improved basic research studies are required to improve this important aspect of trauma care.
Stahel
Philip F
PF
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado 80204, USA. philip.stahel@dhha.org
Moore
Ernest E
EE
Schreier
Star L
SL
Flierl
Michael A
MA
Kashuk
Jeffry L
JL
D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D001803:Blood Transfusion; D002985:Clinical Protocols; D004912:Erythrocytes; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D010949:Plasma; D017713:Platelet Transfusion; D013916:Thrombelastography; D014947:Wounds and Injuries / Q000150:complications*
D005340:Fibrinogen