How to manage coagulopathies in critically ill patients

doi:10.1007/s00134-023-06980-6

Review

. 2023 Mar;49(3):273-290.

doi: 10.1007/s00134-023-06980-6. Epub 2023 Feb 17.

How to manage coagulopathies in critically ill patients

Julie Helms^{1

2}, Toshiaki Iba³, Jean Marie Connors⁴, Satoshi Gando^{5

6}, Marcel Levi^{7

8}, Ferhat Meziani^{9

10}, Jerrold H Levy¹¹

Affiliations

¹ Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. Julie.helms@chru-strasbourg.fr.
² INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France. Julie.helms@chru-strasbourg.fr.
³ Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
⁴ Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, USA.
⁶ Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.
⁷ Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
⁸ Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-Metabolic Programme-NIHR UCLH/UCL BRC London, London, UK.
⁹ Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
¹⁰ INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
¹¹ Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.

PMID: 36808215
DOI: 10.1007/s00134-023-06980-6

Review

How to manage coagulopathies in critically ill patients

Julie Helms et al. Intensive Care Med. 2023 Mar.

. 2023 Mar;49(3):273-290.

doi: 10.1007/s00134-023-06980-6. Epub 2023 Feb 17.

Authors

Julie Helms^{1

2}, Toshiaki Iba³, Jean Marie Connors⁴, Satoshi Gando^{5

6}, Marcel Levi^{7

8}, Ferhat Meziani^{9

10}, Jerrold H Levy¹¹

Affiliations

¹ Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. Julie.helms@chru-strasbourg.fr.
² INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France. Julie.helms@chru-strasbourg.fr.
³ Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
⁴ Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, USA.
⁶ Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.
⁷ Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
⁸ Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-Metabolic Programme-NIHR UCLH/UCL BRC London, London, UK.
⁹ Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
¹⁰ INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
¹¹ Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.

PMID: 36808215
DOI: 10.1007/s00134-023-06980-6

Abstract

Coagulopathy is a severe and frequent complication in critically ill patients, for which the pathogenesis and presentation may be variable depending on the underlying disease. Based on the dominant clinical phenotype, the current review differentiates between hemorrhagic coagulopathies, characterized by a hypocoagulable and hyperfibrinolysis state, and thrombotic coagulopathies with a systemic prothrombotic and antifibrinolytic phenotype. We discuss the differences in pathogenesis and treatment of the common coagulopathies.

Keywords: Coagulopathy; Critical care; Disseminated intravascular coagulation; Hematological disease; Sepsis; Trauma.

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References

1. Hjorleifsson E, Sigurdsson MI, Gudmundsdottir BR, Sigurdsson GH, Onundarson PT (2015) Prediction of survival in patients suspected of disseminated intravascular coagulation. Acta Anaesthesiol Scand 59:870–880. https://doi.org/10.1111/aas.12537 - DOI - PubMed
1. Kleinveld DJB, Hamada SR, Sandroni C (2022) Trauma-induced coagulopathy. Intensive Care Med. https://doi.org/10.1007/s00134-022-06834-7 - DOI - PubMed
1. Callcut RA, Kornblith LZ, Conroy AS, Robles AJ, Meizoso JP, Namias N, Meyer DE, Haymaker A, Truitt MS, Agrawal V, Haan JM, Lightwine KL, Porter JM, San Roman JL, Biffl WL, Hayashi MS, Sise MJ, Badiee J, Recinos G, Inaba K, Schroeppel TJ, Callaghan E, Dunn JA, Godin S, McIntyre RC Jr, Peltz ED, O’Neill PJ, Diven CF, Scifres AM, Switzer EE, West MA, Storrs S, Cullinane DC, Cordova JF, Moore EE, Moore HB, Privette AR, Eriksson EA, Cohen MJ, Western Trauma Association Multicenter Study G (2019) The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg 86:864–870. https://doi.org/10.1097/TA.0000000000002205 - DOI - PMC - PubMed
1. McLintock C (2020) Prevention and treatment of postpartum hemorrhage: focus on hematological aspects of management. Hematol Am Soc Hematol Educ Progr 2020:542–546. https://doi.org/10.1182/hematology.2020000139 - DOI
1. Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De’Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K (2013) The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost 11:307–314. https://doi.org/10.1111/jth.12078 - DOI - PubMed

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[1] Hjorleifsson E, Sigurdsson MI, Gudmundsdottir BR, Sigurdsson GH, Onundarson PT (2015) Prediction of survival in patients suspected of disseminated intravascular coagulation. Acta Anaesthesiol Scand 59:870–880. https://doi.org/10.1111/aas.12537 - DOI - PubMed

[2] Hjorleifsson E, Sigurdsson MI, Gudmundsdottir BR, Sigurdsson GH, Onundarson PT (2015) Prediction of survival in patients suspected of disseminated intravascular coagulation. Acta Anaesthesiol Scand 59:870–880. https://doi.org/10.1111/aas.12537 - DOI - PubMed

[3] Kleinveld DJB, Hamada SR, Sandroni C (2022) Trauma-induced coagulopathy. Intensive Care Med. https://doi.org/10.1007/s00134-022-06834-7 - DOI - PubMed

[4] Kleinveld DJB, Hamada SR, Sandroni C (2022) Trauma-induced coagulopathy. Intensive Care Med. https://doi.org/10.1007/s00134-022-06834-7 - DOI - PubMed

[5] Callcut RA, Kornblith LZ, Conroy AS, Robles AJ, Meizoso JP, Namias N, Meyer DE, Haymaker A, Truitt MS, Agrawal V, Haan JM, Lightwine KL, Porter JM, San Roman JL, Biffl WL, Hayashi MS, Sise MJ, Badiee J, Recinos G, Inaba K, Schroeppel TJ, Callaghan E, Dunn JA, Godin S, McIntyre RC Jr, Peltz ED, O’Neill PJ, Diven CF, Scifres AM, Switzer EE, West MA, Storrs S, Cullinane DC, Cordova JF, Moore EE, Moore HB, Privette AR, Eriksson EA, Cohen MJ, Western Trauma Association Multicenter Study G (2019) The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg 86:864–870. https://doi.org/10.1097/TA.0000000000002205 - DOI - PMC - PubMed

[6] Callcut RA, Kornblith LZ, Conroy AS, Robles AJ, Meizoso JP, Namias N, Meyer DE, Haymaker A, Truitt MS, Agrawal V, Haan JM, Lightwine KL, Porter JM, San Roman JL, Biffl WL, Hayashi MS, Sise MJ, Badiee J, Recinos G, Inaba K, Schroeppel TJ, Callaghan E, Dunn JA, Godin S, McIntyre RC Jr, Peltz ED, O’Neill PJ, Diven CF, Scifres AM, Switzer EE, West MA, Storrs S, Cullinane DC, Cordova JF, Moore EE, Moore HB, Privette AR, Eriksson EA, Cohen MJ, Western Trauma Association Multicenter Study G (2019) The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg 86:864–870. https://doi.org/10.1097/TA.0000000000002205 - DOI - PMC - PubMed

[7] McLintock C (2020) Prevention and treatment of postpartum hemorrhage: focus on hematological aspects of management. Hematol Am Soc Hematol Educ Progr 2020:542–546. https://doi.org/10.1182/hematology.2020000139 - DOI

[8] McLintock C (2020) Prevention and treatment of postpartum hemorrhage: focus on hematological aspects of management. Hematol Am Soc Hematol Educ Progr 2020:542–546. https://doi.org/10.1182/hematology.2020000139 - DOI

[9] Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De’Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K (2013) The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost 11:307–314. https://doi.org/10.1111/jth.12078 - DOI - PubMed

[10] Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De’Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K (2013) The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost 11:307–314. https://doi.org/10.1111/jth.12078 - DOI - PubMed

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How to manage coagulopathies in critically ill patients

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How to manage coagulopathies in critically ill patients

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