Kataria Sahil, Juneja Deven, Singh Omender
Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, India.
Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India.
World J Crit Care Med. 2025 Jun 9;14(2):102521. doi: 10.5492/wjccm.v14.i2.102521.
Management of patients with acute hemorrhage requires addressing the source of bleeding, replenishing blood volume, and addressing any coagulopathy that may be present. Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges. In these patients, transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality. Moreover, ratio-based concepts do not stop bleeding; instead, they just give physicians more time to identify the bleeding source and plan management strategies. In clinical practice, standard laboratory coagulation tests (SLCT) are frequently used to assess various aspects of blood clotting. However, these tests may not always offer a comprehensive understanding of clinically significant coagulopathy and the severity of blood loss. Furthermore, the SLCT have a considerable turnaround time, which may not be ideal for making prompt clinical decisions. In recent years, there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelastometry, which provide real-time, dynamic information about clot formation and dissolution.
急性出血患者的管理需要解决出血源、补充血容量以及处理可能存在的任何凝血病。对于正在出血的患者，实时评估凝血病并预测血液需求量可能会带来巨大挑战。在这些患者中，基于比例的输血概念并不能有效解决凝血病或降低死亡率。此外，基于比例的概念并不能止血；相反，它们只是给医生更多时间来确定出血源并制定管理策略。在临床实践中，标准实验室凝血试验（SLCT）经常用于评估血液凝固的各个方面。然而，这些试验可能并不总能全面了解具有临床意义的凝血病和失血的严重程度。此外，SLCT的周转时间相当长，这对于迅速做出临床决策可能并不理想。近年来，人们对即时弹性成像检测（如旋转血栓弹力图）越来越感兴趣，这种检测可提供有关血凝块形成和溶解的实时、动态信息。
