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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -3 مورد

Intraoperative persistent microvascular bleeding: Example of a management protocol using standard and viscoelastic tests

Intraoperative persistent microvascular bleeding: Example of a management protocol using standard and viscoelastic tests
An institutional goal-directed algorithm is useful to manage persistent microvascular bleeding during surgery (defined as bleeding without an apparent surgical site), and guide appropriate intraoperative transfusion decisions. This example is based on results of standard laboratory tests and VET results (thromboelastometry [ROTEM] or thromboelastography [TEG], if available). Adjustments may be made to accommodate local or national guidelines.*¶ This algorithm is not meant for use in patients with known or suspected residual anticoagulant activity. Refer to UpToDate's content on perioperative management of patients receiving anticoagulants. This algorithm is not meant for use in patients with significant hemorrhage or those requiring massive blood transfusion.

ACT: activated clotting time; aPTT: activated partial thromboplastin time; CBC: complete blood count; DIC: disseminated intravascular coagulation; EXTEM CT: clot time using thromboelastometry; FFP: fresh frozen plasma; FIBTEM A10: clot strength measured as the point of displacement 10 min after initial clot formation using thromboelastometry; Hb: hemoglobin; INR: international normalized ratio; IU: international units; MA: amplitude measured at peak clot strength using thromboelastography; PCC: prothrombin complex concentrate; PT: prothrombin time; RBCs: red blood cells; r-TEG: rapid thromboelastography; VET: viscoelastic testing.

* Refer to UpToDate content on management of intraoperative bleeding.

¶ Refer to UpToDate content on point-of-care hemostasis testing (viscoelastic tests).

Δ Higher fibrinogen targets may be needed in some individuals, especially in patients who are pregnant, or if fibrinogen levels are dropping or bleeding persists despite other measures.

◊ Either 3-factor or 4-factor PCC.

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