Transfusion in trauma: empiric or guided therapy?
A state of the art lecture titled “Transfusion therapy in trauma—what to give? Empiric vs guided” was presented at the International Society on Thrombosis and Haemostasis Congress in 2024. Uncontrolled bleeding is the commonest preventable cause of death after traumatic injury. Hemostatic resuscitat...
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Elsevier
2025-01-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037924003583 |
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| author | Liam Barrett Nicola Curry |
| author_facet | Liam Barrett Nicola Curry |
| author_sort | Liam Barrett |
| collection | DOAJ |
| description | A state of the art lecture titled “Transfusion therapy in trauma—what to give? Empiric vs guided” was presented at the International Society on Thrombosis and Haemostasis Congress in 2024. Uncontrolled bleeding is the commonest preventable cause of death after traumatic injury. Hemostatic resuscitation is the foundation of contemporary transfusion practice for traumatic bleeding and has 2 main aims: to immediately support the circulating blood volume and to treat/prevent the associated trauma-induced coagulopathy. There are 2 broad types of hemostatic resuscitation strategy: empiric ratio-based therapy, often using red blood cells and fresh frozen plasma in a 1:1 ratio, and targeted therapy where the use of platelets, plasma, or fibrinogen is guided by laboratory or viscoelastic hemostatic tests. There are benefits, and limitations, to each strategy and neither approach has yet been shown to improve outcomes across all patient groups. Questions remain, and future directions for improving transfusion therapy are likely to require novel approaches that have greater flexibility to evaluate and treat heterogeneous trauma cohorts. Such approaches may include the integration of machine learning technologies in clinical systems, with real-time linkage of clinical and laboratory data, to aid early recognition of patients at the greatest risk of bleeding and to direct and individualize transfusion therapies. Greater mechanistic understanding of the underlying pathobiology of trauma-induced coagulopathy and the direct effects of common treatments on this process will be of equal importance to the development of new treatments. Finally, we summarize relevant new data on this topic presented at the 2024 ISTH Congress. |
| format | Article |
| id | doaj-art-198bd16264b5446fbb2bcaf97e12399f |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-198bd16264b5446fbb2bcaf97e12399f2025-01-11T06:41:48ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792025-01-0191102663Transfusion in trauma: empiric or guided therapy?Liam Barrett0Nicola Curry1Oxford Haemophilia and Thrombosis Centre, Department of Haematology, Oxford University Hospitals National Health Service Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK; Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UKOxford Haemophilia and Thrombosis Centre, Department of Haematology, Oxford University Hospitals National Health Service Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK; Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK; Correspondence Nicola Curry, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.A state of the art lecture titled “Transfusion therapy in trauma—what to give? Empiric vs guided” was presented at the International Society on Thrombosis and Haemostasis Congress in 2024. Uncontrolled bleeding is the commonest preventable cause of death after traumatic injury. Hemostatic resuscitation is the foundation of contemporary transfusion practice for traumatic bleeding and has 2 main aims: to immediately support the circulating blood volume and to treat/prevent the associated trauma-induced coagulopathy. There are 2 broad types of hemostatic resuscitation strategy: empiric ratio-based therapy, often using red blood cells and fresh frozen plasma in a 1:1 ratio, and targeted therapy where the use of platelets, plasma, or fibrinogen is guided by laboratory or viscoelastic hemostatic tests. There are benefits, and limitations, to each strategy and neither approach has yet been shown to improve outcomes across all patient groups. Questions remain, and future directions for improving transfusion therapy are likely to require novel approaches that have greater flexibility to evaluate and treat heterogeneous trauma cohorts. Such approaches may include the integration of machine learning technologies in clinical systems, with real-time linkage of clinical and laboratory data, to aid early recognition of patients at the greatest risk of bleeding and to direct and individualize transfusion therapies. Greater mechanistic understanding of the underlying pathobiology of trauma-induced coagulopathy and the direct effects of common treatments on this process will be of equal importance to the development of new treatments. Finally, we summarize relevant new data on this topic presented at the 2024 ISTH Congress.http://www.sciencedirect.com/science/article/pii/S2475037924003583major hemorrhagerandomized controlled trialstransfusion protocolstraumatrauma-induced coagulopathy |
| spellingShingle | Liam Barrett Nicola Curry Transfusion in trauma: empiric or guided therapy? Research and Practice in Thrombosis and Haemostasis major hemorrhage randomized controlled trials transfusion protocols trauma trauma-induced coagulopathy |
| title | Transfusion in trauma: empiric or guided therapy? |
| title_full | Transfusion in trauma: empiric or guided therapy? |
| title_fullStr | Transfusion in trauma: empiric or guided therapy? |
| title_full_unstemmed | Transfusion in trauma: empiric or guided therapy? |
| title_short | Transfusion in trauma: empiric or guided therapy? |
| title_sort | transfusion in trauma empiric or guided therapy |
| topic | major hemorrhage randomized controlled trials transfusion protocols trauma trauma-induced coagulopathy |
| url | http://www.sciencedirect.com/science/article/pii/S2475037924003583 |
| work_keys_str_mv | AT liambarrett transfusionintraumaempiricorguidedtherapy AT nicolacurry transfusionintraumaempiricorguidedtherapy |