Κατεύθυνση Θρόμβωση-Αιμορραγία-Ιατρική των μεταγγίσεων
Library of the School of Health Sciences

2016-01-25

2016

Παντελής Αθανάσιος

Αναπληρωτής Καθηγητής Χειρουργικής Ευάγγελος Φελέκουρας, Καθηγήτρια Αιματολογίας Ωραιάνθη Τραυλού, Επίκουρος Καθηγητής Χειρουργικής Δημήτριος Δημητρούλης

Μαζική Αιμορραγία - Μία σύγχρονη κλινική προσέγγιση βασισμένη σε ενδείξεις & παθοφυσιολογικούς μηχανισμούς.

Greek

Massive hemorrhage - a modern clinical approach based on evidence and pathophysiological mechanisms.

Massive hemorrhage constitutes a clinical and laboratory challenge, faced daily
by physicians and surgeons of every subspecialty. The archetypal condition of
massive hemorrhage is trauma, for the prevention and management of which the
key role is held by prompt recognition.

Recently, there has been great progress regarding the comprehension of the
underlying pathophysiological mechanisms. Massive hemorrhage induces
hemostatic derangements, which are evident in up to 25% of multitrauma patients
arriving to the Emergency Department. These derangements are heralded in
sequence by tissue hypoperfusion and endothelial activation, deviation of
thrombin from a prothrombotic to an anticoagulant phenotype, activation of the
pathway of protein C and subsequently attenuation of the coagulatioin cascade
and triggering of fibrinolysis. This process feedbacks the vicious circle of
massive hemorrhage, which is proportional to the severity of injury and the
duration of the latency period until resuscitation is initiated. As such,
post-traumatic hemorrhagic disorders are classified as a separate entity, known
as Acute Coagulopathy of Trauma/Shock (ACoTS). Traditional resuscitation
strategies (i.e. massive administration of fluids, non-balanced transfusion of
blood products etc) further worsen hemostasis, because they promote
hemodilution and coagulation factor consumption and aggravate acidosis and
hypothermia. The coagulopathy induced by iatrogenic inteventions is called
Resuscitation-Associated Coagulopathy (RAC).

The above-mentioned breakthrough discoveries on pathogenesis have fomulated a
bundle of targeted interventions (i.e. massive transfusion protocols; targeted
transfusion with the use of point-of-care tests such as rotational
thromboelastometry; adjuvant pharmacologic agents, such as tranexamic acid
etc.). Conclusions drawn from research on post-traumatic hemorrhage contribute
to the comprehension of the mechanisms underlying massive hemorrhage in other
clinical settings (i.e. intra-operative, upper gastointestinal, post-partum
etc.) and the amelioration of clinical outcome. What is more, a paradigm shift
is taking place regarding the very definition of massive hemorrhage, from a
sinister complication to a manageable clinical entity.

Massive hemorrhage, Acute coagulopathy of trauma/shock (ACoTS), Massive transfusion protocols, Thromboelastography, APC pathway

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https://pergamos.lib.uoa.gr/uoa/dl/object/1312370