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 2024/04/19
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.