By Carlo Enrique Marcucci, Patrick Schoettker
All anesthesiologists are faced with sufferers who convey bleeding disorders,
whether congenital, got, or pharmacologically brought about. even if many
studies, meta-analyses, guidance, and textbooks were released on the
subject, they normally hide particular facets or require a radical wisdom of
hemostasis. The aim of this publication is to supply the anesthesiologist with an overview
of hemostasis and the mechanisms underlying bleeding and coagulation in
general and to help within the realizing of particular coagulation issues as
they might take place within the quite a few anesthesia subspecialties. it truly is was hoping that, through
the provision of useful info and instruments, the booklet may help citizens and
trained anesthesiologists to control some of the most complex demanding situations that they
face: the bleeding sufferer. an entire knowing of coagulation calls for a lifelong
career, and this booklet isn't meant to interchange the consulting hematologist,
whose professional opinion must always be sought. The to be had procoagulant
blood items and medication all have in all probability harmful side-effects;
furthermore, in bleeding issues pitfalls are widespread and a misdiagnosis can
have in all likelihood catastrophic results. the purpose of the editors is thus
instead to augment the collaboration among the disciplines of Anesthesiology and Hematology.
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Extra resources for Perioperative Hemostasis: Coagulation for Anesthesiologists
Heim (*) • P. E. Marcucci, P. 1007/978-3-642-55004-1_3, © Springer-Verlag Berlin Heidelberg 2015 25 26 C. Heim and P. Schoettker bleeding, especially following major trauma. Today, commercially available viscoelastic tests can be carried out at the bedside and provide the first results within 5 min. There is growing evidence that they may identify early coagulation deficits and thereby facilitate timely goal-directed blood component therapy. Although there is a lack of standardization and evidence-based guidelines for interpretation, these tests are in widespread use in complex surgery and perioperative trauma care.
Heim and P. Schoettker The determination of activated clotting time (ACT) is another piece of information that existing test methods can provide through the incorporation of tissue factor and kaolin into a TEG® sample cup. Viscoelastic tests may also be helpful in screening for hypercoagulable states. TEG® and ROTEM® analyses of patients with a history of thromboembolic complications showed shorter R values and accelerated clot propagation when compared to healthy reference subjects. An increased maximal amplitude (MA) may be a useful indicator of the risk of postoperative thromboembolic events.
Time from the initiation of clotting to the achievement of clot firmness at 20 mm. Represents the initial rate of fibrin polymerization. Simplified: depends on fibrin polymerization, platelets and FXIII (acting as clot stabilizer). α angle Indicates the speed at which a solid clot forms. Simplified: depending on platelet function and to lesser extent to fibrinogen and coagulation factors. MCF Maximum clot firmness and viscoelastic strength. Simplified: clot strength depends mainly on polymerized fibrin, platelets and FXIII.