Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Austria.
Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria.
Hamostaseologie. 2021 Aug;41(4):307-315. doi: 10.1055/a-1232-7721. Epub 2020 Sep 7.
Hemorrhage after trauma remains a significant cause of preventable death. Trauma-induced coagulopathy (TIC) at the time of hospital admission is associated with an impaired outcome. Rather than a universal phenotype, TIC represents a complex hemostatic disorder, and standard coagulation tests are not designed to adequately reflect the complexity of TIC. Viscoelastic testing (VET) has gained increasing interest for the characterization of TIC because it provides a more comprehensive depiction of the coagulation process. Thus, VET has been established as a point-of-care-available hemostatic monitoring tool in many trauma centers. Damage-control resuscitation and early administration of tranexamic acid provide the basis for treating TIC. To improve survival, ratio-driven massive transfusion protocols favoring early and high-dose plasma transfusion have been implemented in many trauma centers around the world. Although plasma contains all coagulation factors and inhibitors, only high-volume plasma transfusion allows for adequate substitution of lacking coagulation proteins. However, high-volume plasma transfusion has been associated with several relevant risks. In some European trauma facilities, a more individualized hemostatic therapy concept has been implemented. The hemostatic profile of the bleeding patient is evaluated by VET. Subsequently, goal-directed hemostatic therapy is primarily based on coagulation factor concentrates such as fibrinogen concentrate or prothrombin complex concentrate. However, a clear difference in survival benefit between these two treatment strategies has not yet been shown. This concise review aims to summarize current evidence for different diagnostic and therapeutic strategies in patients with TIC.
创伤后出血仍然是可预防死亡的一个重要原因。入院时的创伤诱导性凝血障碍（TIC）与预后不良有关。TIC 不是一种普遍的表型，而是一种复杂的止血障碍，标准凝血测试设计不能充分反映 TIC 的复杂性。粘弹性测试（VET）因其能更全面地描述凝血过程而越来越受到 TIC 特征描述的关注。因此，VET 已在许多创伤中心确立为一种即时可用的止血监测工具。损伤控制性复苏和早期给予氨甲环酸为治疗 TIC 提供了基础。为了提高存活率，许多创伤中心实施了以比例为导向的大量输血方案，优先考虑早期和高剂量的血浆输注。尽管血浆包含所有凝血因子和抑制剂，但只有大容量血浆输注才能充分替代缺乏的凝血蛋白。然而，大容量血浆输注与一些相关风险有关。在一些欧洲创伤机构中，已经实施了一种更加个体化的止血治疗概念。通过 VET 评估出血患者的止血特征。随后，基于目标的止血治疗主要基于凝血因子浓缩物，如纤维蛋白原浓缩物或凝血酶原复合物浓缩物。然而，这两种治疗策略在存活率方面的明显差异尚未得到证实。这篇简明的综述旨在总结目前关于 TIC 患者不同诊断和治疗策略的证据。
