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Potential value of pharmacological protocols in trauma

机译：药理学方案在创伤中的潜在价值

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Purpose of Review: Diagnosis and treatment of trauma-induced coagulopathy (TIC) presents a challenge for trauma care providers. Viscoelastic tests (VETs) including thromboelastometry and thrombelastography are increasingly used to diagnose TIC and guide hemostatic therapy. We summarize the concept of individualized, goal-directed coagulation management using coagulation factor concentrates. Recent Findings: Early and aggressive treatment is mandatory to improve the survival of severely bleeding trauma patients. High ratios of fresh frozen plasma to red blood cells are linked to improved outcome in coagulopathic patients; however, treatment is often delayed because most blood products must first be thawed. Lyophilized plasma potentially overcomes these problems. However, until now only limited data on the use of lyophilized plasma in major trauma are available. VETs provide a rapid and comprehensive overview of the coagulation process. Low maximum clot firmness is associated with increased transfusion requirements, and premature lysis of the clot is indicative of poor outcome. Improvement in clot firmness can be achieved by the administration of fibrinogen concentrate or platelet concentrate, depending on the cause of coagulopathy. Early administration of tranexamic acid improves clot stability and outcome in major trauma. Prothrombin complex concentrate increases thrombin generation, but is potentially associated with increased risk of thromboembolic complications. Summary: VETs are useful in the diagnosis of TIC, allowing precise deficits in the coagulation process to be identified and specifically targeted with coagulation factor concentrates. ? 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
机译：审查目的：外伤性凝血病（TIC）的诊断和治疗对外伤护理人员提出了挑战。包括血栓弹力测定法和血栓弹力描记术在内的粘弹性测试（VET）越来越多地用于诊断TIC和指导止血疗法。我们总结了使用凝血因子浓缩物进行个性化，目标导向的凝血管理的概念。最新发现：必须进行早期积极治疗以改善严重出血创伤患者的生存率。新鲜的冷冻血浆与红细胞的高比例与凝血病患者的预后改善有关。但是，由于大多数血液制品必须首先解冻，因此治疗通常会延迟。冻干血浆可以克服这些问题。然而，到目前为止，只有很少的关于冻干血浆在严重创伤中使用的数据。 VET提供了对凝血过程的快速而全面的概述。低的最大血凝块硬度与增加的输血需求有关，血凝块的过早裂解表明预后不良。根据凝血病的原因，可通过施用纤维蛋白原浓缩物或血小板浓缩物来改善血凝块硬度。早期给予氨甲环酸可以改善血块的稳定性和严重创伤的预后。凝血酶原复合物浓缩物增加了凝血酶的产生，但可能与血栓栓塞并发症的风险增加有关。简介：VET可用于TIC的诊断，可确定凝血过程中的确切缺陷，并专门针对凝血因子浓缩物。 ？ 2013威科集团健康|利平科特·威廉姆斯和威尔金斯。

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