About this Research Topic
Over the past few decades, the underlying pathological processes of severe hemorrhage in various clinical scenarios have been increasingly recognized and management strategies involved are evolving. Typically, bleeding is controlled by timely surgical interventions alongside hemodynamic resuscitation and treatment of coagulation disorders. Early detection of abnormal coagulation and immediate hemostatic support is essential, as coagulopathy contributes to the development of massive bleeding. The goal of personalized therapy for patients with severe bleeding and coagulopathy is to provide the proper products to the adequate patient at the right time. Viscoelastic hemostasis assays (VHA) have the potential to guide coagulation therapy according to the actual needs of each patient, reducing the risks of over- or under-transfusion. Unanswered questions include whether ratio-driven strategies (FFP/RBC) are superior to coagulation factor-driven interventions for initial coagulation resuscitation, whether PCC is equivalent to fresh frozen plasma, or how to identify patients with the most benefit from TXA therapy.
A critical appraisal of the literature on critical bleeding is crucial before applying the findings of specific studies to our clinical practice. The results of trials may be influenced by the significant heterogeneity of the study population (due to the non-standard definition of massive transfusion) or by the variable definition of hemostatic disorders (due to the inconsistent cut-off values of different VHA to define abnormalities). It is also essential that authors report the precise timing of events (the time of hospital admission, laboratory measurements, hemostatic interventions, transfusions, and surgical measures). In hemorrhagic shock, differences in minutes between the study groups can be of significance and modify the risk and/or outcomes.
This Special Issue focuses on critical bleeding in different clinical scenarios, such as perioperative settings, major trauma, and postpartum periods or GI bleeding. The aims of this issue are:
1. to obtain insights into the novel findings of bleeding pathophysiology and highlight the parallels and differences of coagulopathies in specific bleeding states
2. to review the epidemiology and the laboratory and prognostic markers of massive bleeding in order to standardize the definition of massive transfusion
3. to analyze the data related to VHA guided resuscitation in which cut-off values are combined with clinical signs of disease severity and shock
4. to publish results of national audits focused on the benefit and risk of coagulation factor-driven hemostatic management and present country-specific treatment algorithms in different clinical scenarios
This research topic accepts multiple types of manuscript, including original research, case reports, data reports and editorials.
A critical appraisal of the literature on critical bleeding is crucial before applying the findings of specific studies to our clinical practice. The results of trials may be influenced by the significant heterogeneity of the study population (due to the non-standard definition of massive transfusion) or by the variable definition of hemostatic disorders (due to the inconsistent cut-off values of different VHA to define abnormalities). It is also essential that authors report the precise timing of events (the time of hospital admission, laboratory measurements, hemostatic interventions, transfusions, and surgical measures). In hemorrhagic shock, differences in minutes between the study groups can be of significance and modify the risk and/or outcomes.
This Special Issue focuses on critical bleeding in different clinical scenarios, such as perioperative settings, major trauma, and postpartum periods or GI bleeding. The aims of this issue are:
1. to obtain insights into the novel findings of bleeding pathophysiology and highlight the parallels and differences of coagulopathies in specific bleeding states
2. to review the epidemiology and the laboratory and prognostic markers of massive bleeding in order to standardize the definition of massive transfusion
3. to analyze the data related to VHA guided resuscitation in which cut-off values are combined with clinical signs of disease severity and shock
4. to publish results of national audits focused on the benefit and risk of coagulation factor-driven hemostatic management and present country-specific treatment algorithms in different clinical scenarios
This research topic accepts multiple types of manuscript, including original research, case reports, data reports and editorials.
Keywords: Bleeding, Coagulopathy, Viscoelastic hemostasis assay, Goal-directed coagulation therapy
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
