Document Detail


Coagulopathy: its pathophysiology and treatment in the injured patient.
MedLine Citation:
PMID:  17426904     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hemorrhage continues to be one of the leading causes of death following trauma. Trauma patients are susceptible to the early development of coagulopathy and the most severely injured patients are coagulopathic on hospital admission. Hypothermia, acidosis, and dilution from standard resuscitation can worsen the presenting coagulopathy and perpetuate bleeding. Early identification of coagulopathy is dependent on clinical awareness and point of care laboratory values. Routinely used laboratory coagulation parameters fail to adequately describe this state. Thrombelastography is a test that can be done at the bedside and uses whole blood to provide a functional evaluation of coagulation. Rapid diagnosis of coagulopathy, followed by prevention or correction of hypothermia and acidosis should be a priority during the initial evaluation and resuscitation. Judicious use of resuscitation fluids and early replacement of coagulation factors will help prevent iatrogenic hemodilution. This review covers the pathophysiology as well as the clinical and laboratory diagnosis of coagulopathy. Prevention and treatment strategies are discussed, including early transfusion of coagulation factors during massive transfusion and the use of recombinant factor VIIa. Damage control resuscitation is briefly discussed, and it involves the combination of hypotensive resuscitation and hemostatic resuscitation. Finally, a description of the use of fresh whole blood in the military setting is included. Its use has been proven to be safe and beneficial in this setting and warrants further investigation as an adjunct to the management of civilian trauma patients.
Authors:
Brandon H Tieu; John B Holcomb; Martin A Schreiber
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  World journal of surgery     Volume:  31     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-07     Completed Date:  2007-09-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1055-64     Citation Subset:  IM    
Affiliation:
Department of Surgery, Division of Trauma and Critical Care, Oregon Health & Science University, Portland, Oregon 97239, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Coagulation Disorders / diagnosis,  etiology,  physiopathology*,  therapy*
Blood Transfusion
Factor VII
Hemostasis
Humans
Resuscitation / methods
Wounds and Injuries / complications*
Chemical
Reg. No./Substance:
9001-25-6/Factor VII

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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