Coagulation management in multiple XXXX : a systematic review.

@entity1 @entity101 @entity548 @entity301 @entity149 @entity1003 @entity3459 @entity551 @entity130
PURPOSE: The management of @entity130 @entity1 suffering from active @entity548 has improved with a better understanding of @entity130 -induced @entity1003 . The aim of this manuscript is to give recommendations for coagulation management. METHODS: A systematic literature search in the PubMed database was performed for articles published between January 2000 and August 2009. A total of 230 articles were included in the present systematic review. CONCLUSIONS: The " @entity1003 of @entity130 " is a discrete disease which has a decisive influence on survival. Diagnosis and therapy of @entity3459 should start immediately after admission to the emergency department. A specific protocol for massive transfusion should be introduced and continued. Loss of body temperature should be prevented and treated. Acidaemia should be prevented and treated by appropriate shock therapy. If massive transfusion is performed using fresh frozen plasma (FFP), a ratio of FFP to pRBC (packed red blood cells) of 1:2-1:1 should be achieved. Fibrinogen should be substituted at levels of <1.5 g/L. For @entity1 suffering from active @entity548 , permissive @entity551 (i.e. mean arterial pressure ~65 mmHg) may be aimed for until surgical cessation of @entity548 . This option is contraindicated in @entity149 and in @entity1 with @entity301 , or with known @entity101 . Thrombelastography or -metry may be performed to guide coagulation diagnosis and substitution. Hypocalcaemia <0.9 mmol/L should be avoided and may be treated. For actively @entity548 @entity1 , pRBC may be given at haemoglobin <10 g/L (6.2 mmol/L) and haematocrit may be targeted at 30%.
