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Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.

Publication ,  Journal Article
Erdoes, G; Faraoni, D; Koster, A; Steiner, ME; Ghadimi, K; Levy, JH
Published in: Anesthesiology
May 2023

Inherited and acquired coagulopathy are frequently associated with major bleeding in severe trauma, cardiac surgery with cardiopulmonary bypass, and postpartum hemorrhage. Perioperative management is multifactorial and includes preoperative optimization and discontinuation of anticoagulants and antiplatelet therapy in elective procedures. Prophylactic or therapeutic use of antifibrinolytic agents is strongly recommended in guidelines and has been shown to reduce bleeding and need for allogeneic blood administration. In the context of bleeding induced by anticoagulants and/or antiplatelet therapy, reversal strategies should be considered when available. Targeted goal-directed therapy using viscoelastic point-of-care monitoring is increasingly used to guide the administration of coagulation factors and allogenic blood products. In addition, damage control surgery, which includes tamponade of large wound areas, leaving surgical fields open, and other temporary maneuvers, should be considered when bleeding is refractory to hemostatic measures.

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Published In

Anesthesiology

DOI

EISSN

1528-1175

ISSN

0003-3022

Publication Date

May 2023

Volume

138

Issue

5

Start / End Page

535 / 560

Related Subject Headings

  • Postpartum Period
  • Platelet Aggregation Inhibitors
  • Humans
  • Hemostatics
  • Hemorrhage
  • Female
  • Blood Coagulation Disorders
  • Anticoagulants
  • Anesthesiology
  • 3202 Clinical sciences
 

Citation

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Erdoes, G., Faraoni, D., Koster, A., Steiner, M. E., Ghadimi, K., & Levy, J. H. (2023). Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient. Anesthesiology, 138(5), 535–560. https://doi.org/10.1097/aln.0000000000004520
Erdoes, Gabor, David Faraoni, Andreas Koster, Marie E. Steiner, Kamrouz Ghadimi, and Jerrold H. Levy. “Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.Anesthesiology 138, no. 5 (May 2023): 535–60. https://doi.org/10.1097/aln.0000000000004520.
Erdoes G, Faraoni D, Koster A, Steiner ME, Ghadimi K, Levy JH. Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient. Anesthesiology. 2023 May;138(5):535–60.
Erdoes, Gabor, et al. “Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.Anesthesiology, vol. 138, no. 5, May 2023, pp. 535–60. Epmc, doi:10.1097/aln.0000000000004520.
Erdoes G, Faraoni D, Koster A, Steiner ME, Ghadimi K, Levy JH. Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient. Anesthesiology. 2023 May;138(5):535–560.

Published In

Anesthesiology

DOI

EISSN

1528-1175

ISSN

0003-3022

Publication Date

May 2023

Volume

138

Issue

5

Start / End Page

535 / 560

Related Subject Headings

  • Postpartum Period
  • Platelet Aggregation Inhibitors
  • Humans
  • Hemostatics
  • Hemorrhage
  • Female
  • Blood Coagulation Disorders
  • Anticoagulants
  • Anesthesiology
  • 3202 Clinical sciences