Perioperatively acquired disorders of coagulation

Current Opinion in Anaesthesiology
Oliver GrottkeBartolomeu Nascimento

Abstract

To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage. Recent studies highlight the link between low fibrinogen and decreased fibrin polymerization in the development of acquired coagulopathy. Particularly, fibrin(ogen) deficits are observable after cardiopulmonary bypass in cardiac surgery, on arrival at the emergency room in trauma patients, and with ongoing bleeding after child birth. Regarding antithrombotic therapy, although new oral anticoagulants offer the possibility of efficacy and relative safety compared with vitamin K antagonists, reversal of their anticoagulant effect with nonspecific agents, including prothrombin complex concentrate, has provided conflicting results. Specific antidotes, currently being developed, are not yet licensed for clinical use, but initial results are promising. Targeted hemostatic therapy aims to correct coagulopathies in specific clinical settings, and reduce the need for allogeneic transfusions, thus preventing massive transfusion and its deleter...Continue Reading

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Citations

Apr 30, 2016·Critical Care : the Official Journal of the Critical Care Forum·Oliver GrottkeJohn Eikelboom
Sep 19, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Simona SilvettiKenichi A Tanaka
Aug 7, 2018·Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie·Robert WaltereitPetrus J de Vries
Sep 27, 2019·Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs·Kyohei HatoriShinji Miyamoto
Jan 23, 2018·Journal of Surgical Oncology·Joshua CastleDavid Bentrem
Jun 5, 2018·Journal of Pharmaceutical Health Care and Sciences·Tomoki TakaseTohru Hashida
Aug 13, 2020·JGH Open : an Open Access Journal of Gastroenterology and Hepatology·Bernd FroesslerRajvinder Singh

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Methods Mentioned

BETA
confocal microscopy
surgical procedure

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