The pan-European Task Force for Advanced Bleeding Care in Trauma has published updated clinical practice guidelines on the management of major bleeding and coagulopathy following trauma.
The Task Force comprises of a multi-disciplinary team of pan-European experts representing the fields of emergency medicine, surgery, anaesthesiology, haematology and intensive care medicine with representatives from the European Society for Trauma and Emergency Surgery, the European Society of Anaesthesiology, the European Shock Society, the European Society for Emergency Medicine, the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis and the European Society of Intensive Care Medicine.
Key recommendations include:
- Off-label use of recombinant-activated coagulation factor VII should be considered only if major bleeding and traumatic coagulopathy persist despite all other attempts.
- Emergency reversal of vitamin K-dependent oral anticoagulants should include the early use of prothrombin complex concentrate and 5 mg intravenous (IV) phytomenadione.
- For life-threatening bleeding in those receiving dabigatran, idarucizumab 5 g IV is recommended and tranexamic acid is suggested.
- Desmopressin (0.3 μg/kg) should be considered in patients treated with platelet-inhibiting drugs or von Willebrand disease.
The recommendations are published in Critical Care.