Barrett Liam, Curry Nicola
Oxford Haemophilia and Thrombosis Centre, Department of Haematology, Oxford University Hospitals National Health Service Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK.
Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
Res Pract Thromb Haemost. 2024 Dec 24;9(1):102663. doi: 10.1016/j.rpth.2024.102663. eCollection 2025 Jan.
A state of the art lecture titled "Transfusion therapy in trauma-what to give? Empiric vs guided" was presented at the International Society on Thrombosis and Haemostasis Congress in 2024. Uncontrolled bleeding is the commonest preventable cause of death after traumatic injury. Hemostatic resuscitation is the foundation of contemporary transfusion practice for traumatic bleeding and has 2 main aims: to immediately support the circulating blood volume and to treat/prevent the associated trauma-induced coagulopathy. There are 2 broad types of hemostatic resuscitation strategy: empiric ratio-based therapy, often using red blood cells and fresh frozen plasma in a 1:1 ratio, and targeted therapy where the use of platelets, plasma, or fibrinogen is guided by laboratory or viscoelastic hemostatic tests. There are benefits, and limitations, to each strategy and neither approach has yet been shown to improve outcomes across all patient groups. Questions remain, and future directions for improving transfusion therapy are likely to require novel approaches that have greater flexibility to evaluate and treat heterogeneous trauma cohorts. Such approaches may include the integration of machine learning technologies in clinical systems, with real-time linkage of clinical and laboratory data, to aid early recognition of patients at the greatest risk of bleeding and to direct and individualize transfusion therapies. Greater mechanistic understanding of the underlying pathobiology of trauma-induced coagulopathy and the direct effects of common treatments on this process will be of equal importance to the development of new treatments. Finally, we summarize relevant new data on this topic presented at the 2024 ISTH Congress.
一场题为“创伤中的输血治疗——输什么？经验性治疗与指导性治疗”的前沿讲座于2024年在国际血栓与止血学会大会上发表。未控制的出血是创伤性损伤后最常见的可预防死亡原因。止血复苏是当代创伤性出血输血实践的基础，有两个主要目标：立即维持循环血容量以及治疗/预防相关的创伤性凝血病。止血复苏策略主要有两大类：基于比例的经验性治疗，通常按1:1的比例使用红细胞和新鲜冰冻血浆；以及靶向治疗，即根据实验室或粘弹性止血检测结果来指导血小板、血浆或纤维蛋白原的使用。每种策略都有其益处和局限性，而且尚未有任何一种方法被证明能改善所有患者群体的治疗结果。问题依然存在，未来改善输血治疗的方向可能需要采用更具灵活性的新方法，以评估和治疗异质性创伤患者群体。这些方法可能包括将机器学习技术整合到临床系统中，实现临床数据和实验室数据的实时关联，以帮助早期识别出血风险最高的患者，并指导和个体化输血治疗。对创伤性凝血病潜在病理生物学机制以及常用治疗方法对该过程的直接影响有更深入的理解，对于开发新的治疗方法同样重要。最后，我们总结了在2024年国际血栓与止血学会大会上发表的关于该主题的相关新数据。
