title: Novel approaches in management of perioperative coagulopathy.
abstract: OBJECTIVE
  The recent advances in hemostatic monitoring, and discussion of the clinical implications of hemostatic therapies based on different blood components and factor concentrates.
  
  
  RESULTS
  Implementing suitable laboratory tests and transfusion protocols is highly recommended because the laboratory test guided, protocol-driven transfusion approach reduces blood component utilization, and possibly leads to improved outcomes. Timely assessment of coagulation has been difficult using conventional coagulation tests, but thrombocytopenia, fibrin polymerization defects, and fibrinolysis can be quickly assessed on thromboelastometry. The latter testing can be applied to guide the dosing of fibrinogen and prothrombin complex concentrate, which are selectively used to correct fibrinogen deficiency, and improve thrombin generation in acquired coagulopathy. These therapeutic approaches are novel, and potentially effective in reducing the exposure to allogeneic components (e.g., plasma and platelets) and side-effects of transfusion. Although the accessibility of different therapies among different countries, tranexamic acid is widely available, and is an effective blood conservation measure with a good safety profile in various surgical settings.
  
  
  CONCLUSIONS
  Our understanding of perioperative coagulopathy, diagnostic tools, and therapeutic approaches has evolved in recent years. Additional multidisciplinary efforts are required to understand the optimal combinations, cost-effectiveness, and safety profiles of allogeneic components, and available factor concentrates.
authors.affiliation: aDepartment of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA bClinic of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Kenichi A
authors.initials: KA
authors.lastname: Tanaka
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Bader
authors.forename: Klaus
authors.initials: K
authors.lastname: Görlinger
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000628:therapy*; D004548:Elasticity; D005340:Fibrinogen / Q000378:metabolism; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D059035:Perioperative Period; D011516:Prothrombin / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use; D014783:Viscosity
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D011516:Prothrombin; D005340:Fibrinogen