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All About Bleeding

Perioperative Bleeding & Bleeding in Critically Ill Patients

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New Insights on Perioperative Bleeding

This site provides physicians worldwide with the latest information on diagnosis and treatment of perioperative bleeding situations.

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Goal Directed Treatment

In recent years, a new approach to bleeding management is emerging. This approach is based on the use of point-of-care (POC) coagulation testing using either the TEG® or ROTEM® device and coagulation factor concentrates. Using this approach, physicians can determine which coagulation factors are needed to treat patients in a targeted (goal-directed) manner. Using TEG® or ROTEM® devices these analyses can be performed close to, or even in, the operating room, shortening the time it takes to get test results. Therefore, treatment decisions can be made considerably faster than with classical laboratory test which often take 45–60 minutes to complete. Several small scale studies using this approach and fibrinogen concentrate and/or prothrombin complex concentrates have demonstrated that it is possible to considerably reduce the use of allogenic blood products.25, 34, 40, 44

Prothrombin Complex Concentrates (PCCs)

PCCs are most commonly indicated and used in vitamin K antagonist reversal. In Europe they are also indicated for use in all other acquired factor II, VII, IX and X deficiencies.11, 14 Such deficiencies may occur, for instance, following perioperative bleeding.

PCCs offer a rapid and easy method to stabilize coagulation without the risks of fresh frozen plasma (FFP) transfusion, volume overload or pathogen transmission.41 Although larger randomized trial data are not yet available, several retrospective studies on the effectiveness and safety of treatment with PCCs in perioperative bleeding and patients with liver disease do exist.46-49 In one example PCCs were also used for treatment of bleeding in trauma patients in combination with fibrinogen concentrate.50

Fibrinogen (Factor I) Concentrate

Fibrinogen (factor I) concentrate is indicated for acquired hypofibrinogenemia with massive bleeding, inherited hypofibrinogenemia or afibrinogenemia in several countries (Austria, Brazil, Bulgaria, Czech Republic, Germany, Hungary, Iran, Kuwait, Netherlands, Portugal, Romania, Switzerland, Taiwan and Turkey). In the US and some European countries, it is currently only indicated for treatment of congenital fibrinogen deficiencies (afibrinogenemia and hypofibrinogenemia but not dysfibrinogenemia). Some publications suggest that earlier intervention with fibrinogen at higher levels is important to control fibrinogen-related bleeding.44, 51

If you would like to learn more about perioperative bleeding and recent advances to treatment, please visit perioperativebleeding.org.

CSL Behring's products used in the treatment of perioperative bleeding include:

Prothrombin Complex Concentrate (PCC) Fibrinogen (Factor I) Concentrate

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 coagulation factor concentrate.

Last Updated: 10/28/2014 4:15 PM
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