Perioperatively acquired disorders of coagulation.
OBJECTIVE
To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage.


RESULTS
Recent studies highlight the link between low fibrinogen and decreased fibrin polymerization in the development of acquired coagulopathy. Particularly, fibrin(ogen) deficits are observable after cardiopulmonary bypass in cardiac surgery, on arrival at the emergency room in trauma patients, and with ongoing bleeding after child birth. Regarding antithrombotic therapy, although new oral anticoagulants offer the possibility of efficacy and relative safety compared with vitamin K antagonists, reversal of their anticoagulant effect with nonspecific agents, including prothrombin complex concentrate, has provided conflicting results. Specific antidotes, currently being developed, are not yet licensed for clinical use, but initial results are promising.


CONCLUSIONS
Targeted hemostatic therapy aims to correct coagulopathies in specific clinical settings, and reduce the need for allogeneic transfusions, thus preventing massive transfusion and its deleterious outcomes. Although there are specific guidelines for reversing anticoagulation in patients treated with antiplatelet agents or warfarin, there is currently little evidence to advocate comprehensive recommendations to treat drug-induced coagulopathy associated with new oral anticoagulants.
aDepartment of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany bDepartment of Surgical and General Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria cDepartment of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Oliver
O
Grottke
Dietmar
D
Fries
Bartolomeu
B
Nascimento
D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000139:chemically induced / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy
D000933:Antifibrinolytic Agents