title: Point of care and factor concentrate-based coagulation algorithms.
abstract: In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving.
authors.affiliation: Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.affiliation: Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Stein
authors.affiliation: Cardiothoracic ICU, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Jerrold H
authors.initials: JH
authors.lastname: Levy
keywords: Bleeding; Cardiac surgery; Goal-directed transfusions; POC; Patient blood management; Point of care devices; ROTEM®; Thrombelastometry; Transfusion management; Trauma