ArticleSurgery2018
Empiric transfusion strategies during life-threatening hemorrhage.
Article in Surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The ethics of blood stewardship and quantitative futility assessments to predict certain death in neurotrauma patients.Frontiers in medicine · 2026Review
- The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients.Journal of clinical medicine · 2025Review
- Markers of Futile Resuscitation in Traumatic Hemorrhage: A Review of the Evidence and a Proposal for Futility Time-Outs during Massive Transfusion.Journal of clinical medicine · 2024Review
- Trauma-induced coagulopathy.Nature reviews. Disease primers · 2021Review
- Effects of Blood Components and Whole Blood in a Model of Severe Trauma-Induced Coagulopathy.The Journal of surgical research · 2021Article
- Massive transfusion and the response to prehospital plasma: It is all in how you define it.The journal of trauma and acute care surgery · 2020Article
- Untangling Sex Dimorphisms in Coagulation: Initial Steps Toward Precision Medicine for Trauma Resuscitation.Annals of surgery · 2020Review
- Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications.Anesthesia and analgesia · 2019Review
- Redefining postinjury fibrinolysis phenotypes using two viscoelastic assays.The journal of trauma and acute care surgery · 2019Article
- Review of transfusion practices and its outcome in trauma patients at an urban level 1 trauma center in India.Asian journal of transfusion scienceArticle
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundResuscitation guided by thrombelastography improves survival after injury. If bleeding is rapid, however, or if no thrombelastography data are available, the optimal strategy remains controversial. Our current practice gives fresh frozen plasma and red blood cells (1:2) empirically in patients with life-threatening hemorrhage, with subsequent administration based on rapid thrombelastography. We identified patients at risk of massive transfusion at 1 hour, examined their initial rapid thrombelastography, and used this value to provide empiric recommendations about transfusions.
methodsMassive transfusion was defined as >4 units of red blood cells in the first hour. Patients managed by a trauma activation (2014-2017) had an admission rapid thrombelastography analyzed to determine what proportion met thresholds for administration of cryoprecipitate or platelets.
resultsOverall, 35 patients received >4 units of red blood cells in the first hour. Based on the admission rapid thrombelastography, 37% met criteria for both platelets and cryoprecipitate, 35% for either platelets or cryoprecipitate and 29% for neither. Kaplan-Meier analysis showed a significant delay in the administration of cryoprecipitate and platelets compared to fresh frozen plasma.
conclusionPatients who require >4 units of red blood cells within the first hour should receive cryoprecipitate and platelets if thrombelastography results are not available. Point-of-care devices are needed for optimal care of trauma-induced-coagulopathy, but these data offer guidance in their absence.
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