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Multidisciplinary approach to the challenge of hemostasis.

Publication ,  Other
Levy, JH; Dutton, RP; Hemphill, JC; Shander, A; Cooper, D; Paidas, MJ; Kessler, CM; Holcomb, JB; Lawson, JH; Hemostasis Summit Participants,
Published in: Anesth Analg
February 1, 2010

A multidisciplinary panel consisting of experts chosen by the 2 chairs of the group representing experts in anesthesiology, blood banking, hematology, critical care medicine, and various surgical disciplines (trauma, cardiac, pediatric, neurologic, obstetrics, and vascular) convened in January 2008 to discuss hemostasis and management of the bleeding patient across different clinical settings, with a focus on perioperative considerations. Although there are many ways to define hemostasis, one clinical definition would be control of bleeding without the occurrence of pathologic thrombotic events (i.e., when balance among procoagulant, anticoagulant, fibrinolytic, and antifibrinolytic activities is achieved). There are common hemostatic challenges that include lack of scientific evidence and standardized guidelines for the use of therapeutic drugs, need for reliable and rapid laboratory tools for measuring hemostasis, and individual variability. Clinically meaningful and accurate real-time laboratory data reflecting a patient's hemostatic status are needed to guide treatment decisions. Current available routine laboratory tests of hemostasis (e.g., platelet count, prothrombin time/international normalized ratio, and activated partial thromboplastin time) do not reflect the complexity of in vivo hemostasis and can mislead the clinician. Although point-of-care coagulation monitoring tests including measures of thromboelastography/elastometry provide insight into overall hemostatic status, they are time-consuming to perform, complex to interpret, and require trained personnel. There is a particular need to develop laboratory tests that can measure the effects of anticoagulant and antiplatelet agents for individual patients, predict bleeding complications, and guide therapy when and if treatment with blood products or pharmacologic drugs is required. Formation of an organization comprised of specialists who treat bleeding patients will foster multidisciplinary collaborations and promote discussions of the current state of hemostasis treatment and future priorities for hemostasis research. Controlled trials with clinically meaningful end points and suitable study populations, as well as observational studies, investigator-initiated studies, and large registry and database studies are essential to answer questions in hemostasis. Because of the complexities of maintaining hemostatic balance, advances in hemostasis research and continuing communication across specialties are required to improve patient care and outcomes.

Duke Scholars

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 1, 2010

Volume

110

Issue

2

Start / End Page

354 / 364

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • Humans
  • Hemostatics
  • Hemostatic Techniques
  • Hemostasis
  • Hemorrhage
  • Endothelium, Vascular
  • Clinical Trials as Topic
  • Cardiac Surgical Procedures
  • Blood Loss, Surgical
 

Citation

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Levy, J. H., Dutton, R. P., Hemphill, J. C., Shander, A., Cooper, D., Paidas, M. J., … Hemostasis Summit Participants, . (2010). Multidisciplinary approach to the challenge of hemostasis. Anesth Analg. United States. https://doi.org/10.1213/ANE.0b013e3181c84ba5
Levy, Jerrold H., Richard P. Dutton, J Claude Hemphill, Aryeh Shander, David Cooper, Michael J. Paidas, Craig M. Kessler, John B. Holcomb, Jeffrey H. Lawson, and Jeffrey H. Hemostasis Summit Participants. “Multidisciplinary approach to the challenge of hemostasis.Anesth Analg, February 1, 2010. https://doi.org/10.1213/ANE.0b013e3181c84ba5.
Levy JH, Dutton RP, Hemphill JC, Shander A, Cooper D, Paidas MJ, et al. Multidisciplinary approach to the challenge of hemostasis. Vol. 110, Anesth Analg. 2010. p. 354–64.
Levy, Jerrold H., et al. “Multidisciplinary approach to the challenge of hemostasis.Anesth Analg, vol. 110, no. 2, 1 Feb. 2010, pp. 354–64. Pubmed, doi:10.1213/ANE.0b013e3181c84ba5.
Levy JH, Dutton RP, Hemphill JC, Shander A, Cooper D, Paidas MJ, Kessler CM, Holcomb JB, Lawson JH, Hemostasis Summit Participants. Multidisciplinary approach to the challenge of hemostasis. Anesth Analg. 2010. p. 354–364.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 1, 2010

Volume

110

Issue

2

Start / End Page

354 / 364

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • Humans
  • Hemostatics
  • Hemostatic Techniques
  • Hemostasis
  • Hemorrhage
  • Endothelium, Vascular
  • Clinical Trials as Topic
  • Cardiac Surgical Procedures
  • Blood Loss, Surgical