14 Jun 2023 • A new guide offers recommendations for the nonsurgical management of major hemorrhage, which is a challenging clinical problem. The guide was published June 5 in the Canadian Medical Association Journal.

KEY POINTS

• Major hemorrhage is a challenging clinical problem that can occur with traumatic injury, postpartum hemorrhage, major surgery and gastrointestinal bleeding.
• A massive hemorrhage protocol (MHP) should be activated for patients with uncontrolled hemorrhage who meet clinical activation criteria and are expected to need multiple blood products, in addition to red blood cells.
• Tranexamic acid should be considered for patients with major bleeding.
• When the MHP is activated, plasma should be given at a 2-to-1 ratio of red blood cells to plasma; plasma transfusion should subsequently be guided by the results of coagulation tests.
• Platelet transfusion and fibrinogen replacement should be guided by the results of laboratory tests.
• Laboratory testing should be done every hour during active resuscitation to allow for goal-directed administration of blood products.

CONCLUSION Major hemorrhage is life-threatening and its management is challenging, especially in rural settings where specialized blood products and laboratory tests, and source control of the bleeding, are sometimes not available. Massive hemorrhage protocols provide evidence-based guidance and can be adapted depending on the location of bleeding and patient characteristics. Rapid administration of TXA improves patient outcomes except among those with a gastrointestinal bleed.

Source: Canadian Medical Association Journal | Read full story