Anticoagulation, Resuscitation, and Hemostasis

Abstract

Hemorrhage remains a major cause of potentially preventable deaths. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution, and consumption of clotting factors and platelets. Damage control surgery prioritizes early mechanical control of bleeding, while hemostatic resuscitation seeks mitigating the damage caused by a coagulopathy through blood product transfusions. Although early and effective reversal of coagulopathy is documented, the most effective means of preventing coagulopathy of massive transfusion remains debated, and randomized controlled studies are lacking. Viscoelastic whole blood assays like thromboelastography (TEG) and rotational thromboelastometry (ROTEM) can diagnose coagulopathy earlier than other assays. Patients with uncontrolled bleeding who have had an optimal surgical intervention should be treated with hemostatic control resuscitation with early administration of plasma, platelets, and RBCs; this strategy should be guided by TEG/ROTEM analysis.