Journal ArticleDOI
A practical guideline for the haematological management of major haemorrhage.
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TLDR
These updated guidelines are based on new studies, which have provoked reassessment of the principles of managing major haemorrhage in all clinical situations, and which mandate much closer working between hospital blood banks and emergency departments to provide timely transfusion support for patients with major bleeding.Abstract:
The aim of this guideline is to provide recommendations for the haematological management of major haemorrhage in any clinical situation, with practical guidance for Clinical Haematologists and laboratory staff on the content and delivery of major bleeding protocols, including the use of blood components and transfusion alternatives. Management of major haemorrhage in any setting requires a multidisciplinary approach. There have been advances in techniques for resuscitation as well as surgical, radiological and endoscopy interventions, to control bleeding alongside critical care support, but these are beyond the scope of this document. These updated guidelines are based on new studies, which have provoked reassessment of the principles of managing major haemorrhage in all clinical situations, and which mandate much closer working between hospital blood banks and emergency departments to provide timely transfusion support for patients with major bleeding. Alongside changes in the use of blood component therapy, the importance of antifibrinolytics has been demonstrated in the study by the Clinical Randomization of Antifibrinolytics in Significant Haemorrhage (CRASH-2) collaborators (2010). The recognition that tranexamic acid (TA) benefited not only those with massive haemorrhage but also the larger number of patients with, or at risk of, significant haemorrhage (i.e. not only those fulfilling the criteria for massive bleeding) has led to an expansion of our guidelines from massive to major haemorrhage so that we can include this group. Methodsread more
Citations
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References
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Journal ArticleDOI
A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group.
Paul C. Hébert,George A. Wells,Morris A. Blajchman,John C. Marshall,Claudio Martin,Giuseppe Pagliarello,Martin Tweeddale,Irwin Schweitzer,Elizabeth Yetisir +8 more
TL;DR: A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina.
Journal ArticleDOI
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial
TL;DR: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study, and should be considered for use in bleed trauma patients.
A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care
Journal ArticleDOI
Transfusion of plasma, platelets, and red blood cells in a 1: 1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial
John B. Holcomb,Barbara C. Tilley,Sarah Baraniuk,Erin E. Fox,Charles E. Wade,Jeanette M. Podbielski,Deborah J. del Junco,Karen J. Brasel,Karen J. Brasel,Eileen M. Bulger,Rachael A. Callcut,Mitchell J. Cohen,Bryan A. Cotton,Timothy C. Fabian,Kenji Inaba,Jeffrey D. Kerby,Peter Muskat,Peter Muskat,Terence O'Keeffe,Sandro Rizoli,Bryce R.H. Robinson,Thomas M. Scalea,Martin A. Schreiber,Deborah M. Stein,Jordan A. Weinberg,Jeannie Callum,John R. Hess,Nena Matijevic,Christopher N. Miller,Jean-Francois Pittet,David B. Hoyt,Gail D. Pearson,Brian G. Leroux,Gerald van Belle +33 more
TL;DR: In this article, the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1 :1:2 ratio was evaluated.
Journal ArticleDOI
Transfusion strategies for acute upper gastrointestinal bleeding.
Càndid Villanueva,Alan Colomo,Alba Bosch,Mar Concepción,Virginia Hernández-Gea,Carles Aracil,Isabel Graupera,Maria A. Poca,Cristina Alvarez-Urturi,Jordi Gordillo,Carlos Guarner-Argente,Miquel Santaló,Eduardo Muñiz,Carlos Guarner +13 more
TL;DR: As compared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute upper gastrointestinal bleeding.
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