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dc.contributor.authorGall, LSen_US
dc.contributor.authorDavenport, RAen_US
dc.date.accessioned2018-05-25T16:44:43Z
dc.date.available2017-11-03en_US
dc.date.issued2018-04en_US
dc.date.submitted2018-03-03T12:59:53.530Z
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/39069
dc.description.abstractPURPOSE OF REVIEW: The role of antifibrinolytics in trauma haemorrhage and early coagulopathy remains controversial with respect to patient selection, dosage, timing of treatment, and risk of thrombotic complications. This review presents our current understanding of the mechanisms of fibrinolysis in trauma, diagnostic evaluation, and the evidence base for treatment. RECENT FINDINGS: Excessive fibrinolysis following severe injury is a major component of acute traumatic coagulopathy and contributes to the high mortality from trauma haemorrhage. The protein C pathway, endothelial dysfunction, platelet activity, shock, and tissue injury are key to the development of hyper fibrinolysis in trauma. D-dimer and viscoelastic haemostatic assays (rotational thromboelastometry, TEG) remain the best available diagnostic modalities but have a number of limitations compared with plasma biomarkers of fibrinolytic activation, for example, plasmin-α2-antiplasmin complex. Current evidence supports the continued empiric use of tranexamic acid in major trauma haemorrhage. SUMMARY: Improving the outcomes for bleeding trauma patients requires a deeper understanding of the mechanisms driving hyperfibrinolysis and the subsequent switch toward a prothrombotic state. Discovering the interplay between platelet activity, fibrinogen utilization, the immune response, and the fibrinolytic system may lead to development of novel therapeutics.en_US
dc.format.extent227 - 233en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofCurr Opin Anaesthesiolen_US
dc.subjectAntifibrinolytic Agentsen_US
dc.subjectBlood Coagulation Disordersen_US
dc.subjectBlood Coagulation Testsen_US
dc.subjectCritical Careen_US
dc.subjectFibrinolysisen_US
dc.subjectHemorrhageen_US
dc.subjectHumansen_US
dc.subjectPatient Selectionen_US
dc.subjectPractice Guidelines as Topicen_US
dc.subjectThrombosisen_US
dc.subjectTime Factorsen_US
dc.subjectTreatment Outcomeen_US
dc.subjectWounds and Injuriesen_US
dc.titleFibrinolysis and antifibrinolytic treatment in the trauma patient.en_US
dc.typeArticle
dc.identifier.doi10.1097/ACO.0000000000000561en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/29324486en_US
pubs.issue2en_US
pubs.notesNot knownen_US
pubs.publication-statusPublisheden_US
pubs.volume31en_US


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