title: Applying 'Patient Blood Management' in the trauma center.
abstract: OBJECTIVE
  The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed.
  
  
  RESULTS
  Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia.
  
  
  CONCLUSIONS
  Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.
authors.affiliation: Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.forename: Philipp
authors.initials: P
authors.lastname: Stein
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000740:Anemia / Q000628:therapy; D001778:Blood Coagulation Disorders / Q000188:drug therapy*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001803:Blood Transfusion; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D006801:Humans; D019095:Point-of-Care Systems; D014148:Tranexamic Acid / Q000627:therapeutic use; D014193:Trauma Centers
chemical_list: D001779:Blood Coagulation Factors; D014148:Tranexamic Acid; D003894:Deamino Arginine Vasopressin