Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jan 25;14(3):784.
doi: 10.3390/jcm14030784.

Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management

Sofia Bezati  1 , Ioannis Ventoulis  2 , Christos Verras  1 , Antonios Boultadakis  1 , Vasiliki Bistola  3 , Nikolaos Sbyrakis  4 , Othon Fraidakis  5 , Georgia Papadamou  6 , Barbara Fyntanidou  7 , John Parissis  1 , Effie Polyzogopoulou  1
Affiliations
Review

Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management

Sofia Bezati et al. J Clin Med. .

Abstract

Major bleeding is a life-threatening condition with high morbidity and mortality. Trauma, gastrointestinal bleeding, haemoptysis, intracranial haemorrhage or other causes of bleeding represent major concerns in the Emergency Department (ED), especially when complicated by haemodynamic instability. Severity and source of bleeding, comorbidities, and prior use of anticoagulants are pivotal factors affecting both the clinical status and the patients' differential response to haemorrhage. Thus, risk stratification is fundamental in the initial assessment of patients with bleeding. Aggressive resuscitation is the principal step for achieving haemodynamic stabilization of the patient, which will further allow appropriate interventions to be made for the definite control of bleeding. Overall management of major bleeding in the ED should follow a holistic individualized approach which includes haemodynamic stabilization, repletion of volume and blood loss, and reversal of coagulopathy and identification of the source of bleeding. The aim of the present practical guide is to provide an update on recent epidemiological data about the most common etiologies of bleeding and summarize the latest evidence regarding the bundles of care for the management of patients with major bleeding of traumatic or non-traumatic etiology in the ED.

Keywords: bundles of care; emergency department; haemorrhage; major bleeding; practical guide; resuscitation.

PubMed Disclaimer

Conflict of interest statement

S.B., I.V., C.V., A.B., N.S., O.F., G.P. and B.F. have no conflicts of interest or financial ties to disclose. V.B. reports honoraria for lectures or advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, and Roche Diagnostics. J.P. received honoraria for lectures from Orion pharma, Pfizer, Servier, AstraZeneca, AO Orphan and Roche Diagnostics. E.P. received honoraria for lectures from AstraZeneca. For the present study the authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Roadmap for the management of patients with major bleeding in the ED. APTT = Activated Partial Thromboplastin Time; Ca2+ = Ionized Calcium; CT = Computed Tomography; DOACs = Direct Oral Anticoagulants; ED = Emergency Department; FFP = Fresh Frozen Plasma; Hb = Haemoglobin; IIa = Activated Factor II; ICH = Intracranial Haemorrhage; INR = International Normalized Ratio; PCC = Prothrombin Complex Concentrate; PLT = Platelets; POCUS = Point of Care Ultrasonography; SBP = Systolic Blood Pressure; SI = Shock Index; ROTEM = Thromboelastometry; TBI = Traumatic Brain Injury; TEG = Thromboelastography; TXA = Tranexamic Acid; VBG = Venous Blood Gas; Vit = Vitamin; VKA = Vitamin K Antagonists; Xa = Activated Factor X.
See this image and copyright information in PMC

References

    1. Green L., Stanworth S., McQuilten Z., Lin V., Tucker H., Jackson B., Badawi M., Hindawi S., Chaurasia R., Patidar G., et al. International Forum on the Management of Major Haemorrhage: Summary. Vox Sang. 2022;117:746–753. doi: 10.1111/vox.13244. - DOI - PubMed
    1. Schulman S., Kearon C. Definition of Major Bleeding in Clinical Investigations of Antihemostatic Medicinal Products in Non-surgical Patients. J. Thromb. Haemost. 2005;3:692–694. doi: 10.1111/j.1538-7836.2005.01204.x. - DOI - PubMed
    1. Thompson L., Hill M., Lecky F., Shaw G. Defining Major Trauma: A Delphi Study. Scand. J. Trauma Resusc. Emerg. Med. 2021;29:63. doi: 10.1186/s13049-021-00870-w. - DOI - PMC - PubMed
    1. Rossaint R., Afshari A., Bouillon B., Cerny V., Cimpoesu D., Curry N., Duranteau J., Filipescu D., Grottke O., Grønlykke L., et al. The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Sixth Edition. Crit. Care. 2023;27:80. doi: 10.1186/s13054-023-04327-7. - DOI - PMC - PubMed
    1. Subcommittee A.T.L.S. Advanced Trauma Life Support: Student Course Manual. 10th ed. American College of Surgeons; Chicago, IL, USA: 2018.

LinkOut - more resources