Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin CCM/CVK, Augustenburger Platz 1, 13353 Berlin, Germany.
Medical University of Innsbruck, Department of Internal Medicine II, Anichstr. 35, A-6020 Innsbruck, Austria.
Curr Opin Anaesthesiol. 2020 Apr;33(2):246-252. doi: 10.1097/ACO.0000000000000836.
Trauma-associated bleeding and coagulopathy require timely identification, prevention, and effective treatment. The present review summarizes the recent literature around point-of-care (POC) coagulation tests, their usefulness in the management of trauma-induced coagulopathy (TIC), their impact on trauma patient outcomes, and the requirement of quality assurance.
Best practice algorithms to manage TIC have been compiled in the 2019 European Guideline on the management of major bleeding and coagulopathy after trauma. Evidence supports the use of goal-directed approaches to manage TIC. POC coagulation tests can accelerate and tailor individualized therapies. Recent findings emphasize: the time sparing of POC tests in prehospital settings and the validity of POC measurements in extreme environments; the potential scalability of POC-guided TIC algorithms in burn injuries and the pediatric population; the need for careful considerations of strategies to monitor and reverse the effects of direct oral anticoagulants in major trauma.
In contrast to an abundance of reviews and practical approaches to POC coagulation management in trauma patients, there is a scarcity of research in the field and large-scale clinical trials are urgently needed. The paneuropean multicenter trial Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (iTACTIC) will inform on the potential of viscoelastic tests to augment transfusion protocols for better patient outcomes.
创伤相关出血和凝血病需要及时识别、预防和有效治疗。本综述总结了关于即时检测（POC）凝血检测的最新文献，这些检测在创伤性凝血病（TIC）管理中的用途、对创伤患者结局的影响，以及质量保证的要求。
2019 年欧洲创伤后大出血和凝血病管理指南已经编制了 TIC 的最佳实践算法。有证据支持使用靶向治疗方法来管理 TIC。POC 凝血检测可以加速并定制个体化治疗。最近的研究结果强调了：POC 检测在院前环境中的省时性，以及 POC 测量在极端环境下的有效性；POC 指导 TIC 算法在烧伤和儿科人群中的潜在可扩展性；在重大创伤中，需要仔细考虑监测和逆转直接口服抗凝剂作用的策略。
与大量关于创伤患者 POC 凝血管理的综述和实用方法相比，该领域的研究仍然匮乏，迫切需要进行大规模临床试验。泛欧多中心试验 Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (iTACTIC) 将研究关于使用粘弹性检测来增强输血方案以改善患者结局的潜力。
