Two distinct types of treatment protocol are used to manage dysfunctional coagulopathy during perioperative bleeding:
- Treatment using traditional algorithms
- Goal-directed treatment, identifying the part of the coagulation system to be corrected
Empirical treatment algorithms for the use of allogenic blood products were developed because of the need to address a bleeding emergency quickly without the time needed to get results or classical coagulation tests back from the central laboratory in the hospital (often 45–60 minutes).
Traditional algorithms use allogenic blood products (red blood cells (RBCs), fresh frozen plasma (FFP), platelets and cryoprecipitate in different ratios and in different quantities.35-38 In many cases these algorithms are initially not based on a differential assessment of the individual coagulation status of the patient but on a visual assessment of bleeding.39
Fresh Frozen Plasma (FFP)
Though the clinical efficacy of FFP is largely unproven, most guidelines and transfusion protocols recommend its use to control massive bleeding or significant bleeding complicated by coagulopathy.35
The need for platelet transfusion depends upon many factors, not a single laboratory test. Platelets are used to treat or prevent bleeding during surgery or invasive procedures in patients with clinically significant deficiencies in platelet number or function.36-37
Cryoprecipitate may be used in perioperative bleeding when standard transfusion therapy (RBCs, FFP and platelets) fails to correct a coagulopathy, or if a fibrinogen deficiency is identified by laboratory or point-of-care (POC) testing.41
Recombinant factor VIIa
Recombinant factor VIIa has been used for many years in perioperative bleeding. However, despite many case reports and small studies, it has no indication for use in perioperative bleeding, although it is used to treat massive bleeding when all other therapies have failed.38
If you would like to learn more about perioperative bleeding and recent advances to treatment, please visit
Registration status and indications vary from country to country. Please contact your local CSL Behring representative and review the respective prescribing information before considering using a recombinant coagulation factor.
9/10/2014 10:00 AM