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. 2011 Dec 9;108(49):827–835. doi: 10.3238/arztebl.2011.0827

Figure 5.

Figure 5

Current recommendations (according to [13]) for support of coagulation in the early phase after trauma.

Additional measures include normothermia (evidence level 1C), monitoring of the ionized Ca2+ level during massive transfusion (1C), and possibly substitution if levels are low or if there are ECG changes (2C).

*1Target blood pressure 80 to 100 mmHg until achievement of hemostasis in the initial phase after trauma without head injury (1C) / crystalloids as initial treatment for hemorrhaging patients (1B) / hypertonic solutions may also be considered in the initial phase of treatment (2B);

*2Administration within the recommended limits for each individual substance in the case of hemodynamic instability (2C);

*3Administration of erythrocyte concentrates with a target Hb of 7 to 9 g/dL (1C);

*4Early administration of frozen fresh plasma concentrates in patients with massive transfusions, initially at 10 to 15 mL/kg, then according to need (1C);

*5Administration of fibrinogen in the case of severe hemorrhage and simultaneous signs of functional fibrinogen deficit on thrombelastometry (ROTEM) or fibrinogen levels ≤1.5 g/L, initial fibrinogen dose 3 to 4 g, then monitoring by thrombelastometry and fibrinogen level (2C);

*6Administration of thrombocyte concentrates to keep thrombocyte levels above 50×109/L (1C) or above 100×109/L in the case of multiple injury with severe hemorrhage and head injury (2C), initial administration of four to eight bags of thrombocyte concentrate and one apheresis pack (2C);

*7Administration of antifibrinolytics can be considered in bleeding trauma patients (2C; see also CRASH-2 study [20]), monitoring of fibrinolysis by thrombelastometry recommended in all patients, in the case of hyperfibrinolysis administration of antifibrinolytics (1B), initially tranexamic acid 10 to 15 mg/kg followed by infusion 1 to 5 mg/kg/h or -aminocapronic acid 100 to 150 mg/kg followed by 15 mg/kg/h until bleeding is controlled (2C);

*8rFVIIa can be considered if hemorrhage persists despite all efforts to control it and optimal use of blood/coagulation components (2C), before administration of rFVIIa: thrombocytes >50×109/L, fibrinogen >1g/L, hematocrit >24, and pH >7.2