Coagulation management in massive bleeding.
OBJECTIVE
To update readers on recent literature regarding treatment of coagulopathy for patients with life-threatening bleeding, highlighting emerging therapeutic options, controversial topics, and ongoing clinical trials.


RESULTS
Massive transfusion protocols featuring immediate availability of blood products and multidisciplinary communication reduce mortality and conserve resources. There is a growing consensus that immediate administration of plasma and platelet units in a 1: 1: 1 ratio with red cell units reduces early mortality. Lyophilized and recombinant blood product components may have advantages over traditional blood products in certain clinical circumstances.


CONCLUSIONS
Massive transfusion protocols standardize treatment of the coagulopathy of massive bleeding, leading to rapid restoration of hemostasis and decrease in early mortality.
Griffee
Matthew J
MJ
Department of Anesthesiology and Perioperative Medicine, USA. griffeem@ohsu.edu
Deloughery
Thomas G
TG
Thorborg
Per A
PA
D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects*; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000209:etiology; D001803:Blood Transfusion; D003029:Coagulants / Q000627:therapeutic use*; D015942:Factor VIIa / Q000627:therapeutic use; D006400:Hematocrit; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use; D006706:Homeostasis; D006801:Humans; D008887:Military Medicine; D010949:Plasma; D011994:Recombinant Proteins / Q000627:therapeutic use; D012151:Resuscitation; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy
D003029:Coagulants; D006490:Hemostatics; D011994:Recombinant Proteins; D015942:Factor VIIa