RT Book, Section A1 Chang, Ronald A1 Holcomb, John B. A1 Leibner, Evan A1 Pommerening, Matthew A1 Kozar, Rosemary A. A2 Brunicardi, F. Charles A2 Andersen, Dana K. A2 Billiar, Timothy R. A2 Dunn, David L. A2 Kao, Lillian S. A2 Hunter, John G. A2 Matthews, Jeffrey B. A2 Pollock, Raphael E. SR Print(0) ID 1164306618 T1 Hemostasis, Surgical Bleeding, and Transfusion T2 Schwartz's Principles of Surgery, 11e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259835353 LK accessmedicine.mhmedical.com/content.aspx?aid=1164306618 RD 2024/11/04 AB Key PointsThe life span of platelets ranges from 7 to 10 days. Drugs that interfere with platelet function include aspirin, clopidogrel, prasugrel, dipyridamole, and the glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors. Approximately 5 to 7 days should pass from the time the drug is stopped until an elective procedure is performed.Laboratory evidence of trauma-induced coagulopathy is found in up to one-third of severely injured patients at admission. It is distinct from disseminated intravascular coagulopathy and iatrogenic causes of coagulopathy such as hemodilution. Several non–mutually exclusive mechanisms have been proposed. However, the relationship between laboratory coagulation abnormalities and clinically evident coagulopathic bleeding is unclear.Direct oral anticoagulants have no readily available method for monitoring anticoagulation. A new monoclonal antibody has been approved to reverse coagulopathy due to dabigatran, and agents are currently in clinical trials for the reversal of direct factor Xa oral anticoagulants.When determining the need for bridging of therapeutic anticoagulation in the preoperative and postoperative setting, the patient’s risk of bleeding should be carefully considered against the risk of thromboembolism and used to guide the need for reversal of anticoagulation therapy preoperatively and the timing of its reinstatement postoperatively.Damage control resuscitation has three basic components: permissive hypotension, minimizing crystalloid-based resuscitation, and the administration of balanced ratios of blood products.The need for massive transfusion should be anticipated, and guidelines should be in place to provide early and balanced amounts of red blood cells, plasma, and platelets.