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Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy.

Publication ,  Journal Article
Erdoes, G; Goobie, SM; Haas, T; Koster, A; Levy, JH; Steiner, ME
Published in: BJA Open
December 2024

Neonates, infants, and children undergoing major surgery or with trauma can develop severe coagulopathy perioperatively. Neonates and infants are at highest risk because their haemostatic system is not fully developed and underlying inherited bleeding disorders may not have been diagnosed before surgery. Historically, laboratory coagulation measurements have been used to diagnose and monitor coagulopathies. Contemporary dynamic monitoring strategies are evolving. Viscoelastic testing is increasingly being used to monitor coagulopathy, particularly in procedures with a high risk of bleeding. However, there is a lack of valid age-specific reference values for diagnosis and trigger or target values for appropriate therapeutic management. A promising screening tool of primary haemostasis that may be used to diagnose quantitative and qualitative platelet abnormalities is the in vitro closure time by platelet function analyser. Targeted individualised treatment strategies for haemostatic bleeding arising from inherited or acquired bleeding disorders may include measures such as tranexamic acid, administration of plasma, derived or recombinant factors such as fibrinogen concentrate, or allogeneic blood component transfusions (plasma, platelets, or cryoprecipitate). Herein we review current recommended perioperative guidelines, monitoring strategies, and treatment modalities for the paediatric patient with a coagulopathy. In the absence of data from adequately powered prospective studies, it is recommended that expert consensus be considered until additional research and validation of goal-directed perioperative bleeding management in paediatric patients is available.

Duke Scholars

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Published In

BJA Open

DOI

EISSN

2772-6096

Publication Date

December 2024

Volume

12

Start / End Page

100310

Location

England
 

Citation

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Chicago
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Erdoes, G., Goobie, S. M., Haas, T., Koster, A., Levy, J. H., & Steiner, M. E. (2024). Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy. BJA Open, 12, 100310. https://doi.org/10.1016/j.bjao.2024.100310
Erdoes, Gabor, Susan M. Goobie, Thorsten Haas, Andreas Koster, Jerrold H. Levy, and Marie E. Steiner. “Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy.BJA Open 12 (December 2024): 100310. https://doi.org/10.1016/j.bjao.2024.100310.
Erdoes G, Goobie SM, Haas T, Koster A, Levy JH, Steiner ME. Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy. BJA Open. 2024 Dec;12:100310.
Erdoes, Gabor, et al. “Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy.BJA Open, vol. 12, Dec. 2024, p. 100310. Pubmed, doi:10.1016/j.bjao.2024.100310.
Erdoes G, Goobie SM, Haas T, Koster A, Levy JH, Steiner ME. Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy. BJA Open. 2024 Dec;12:100310.

Published In

BJA Open

DOI

EISSN

2772-6096

Publication Date

December 2024

Volume

12

Start / End Page

100310

Location

England