The bleeding patient

Abstract

In the bleeding patient, the first line of management is to replace the blood loss with fluids or blood/blood products in a timely manner to ensure that perfusion to the vital organs is maintained. Securing hemostasis through surgical or other interventions at the earliest opportunity is important to enable successful volume replacement. Coagulopathy associated with inadequate replacement will worsen the bleeding. Unless torrential bleeding is arrested, efforts to replace blood volume and oxygen carrying capacity of blood will fail. The type of coagulopathy can be determined by the use of thromboelastography or plasma based coagulation tests in the laboratory. This will allow appropriate selective component replacement therapy. In those with bleeding as a result of trauma, balanced blood transfusion is advocated. Drugs that improve coagulation work at either the coagulation pathway or at the fibrinolytic pathway. Tranexamic acid prevents the activation of plasminogen to plasmin. Aprotinin inhibits the proteolytic enzymes and prevents fibrinolysis. Activated Factor Vlla increases clot formation at sites of exposed tissue factor.