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- W4360920120 abstract "Of the many potential research questions relevant to transfusion for major bleeding, some (such as identifying when the benefit of transfusion outweighs the risk, or when to change from a pro- to an anti-thrombotic strategy) are likely to require a ‘personalized medicine’ approach requiring novel technology, and some will test innovative artificial substitutes for allogenic blood components. However, clinicians confront many other questions in their daily practice when choosing between currently available alternatives. This narrative review explores the most important of these choices: whether to choose fibrinogen concentrate or cryoprecipitate as a source of fibrinogen replacement; whether to use early empiric factor concentrates in preference to a high-ratio plasma-based resuscitation strategy; whether whole blood has a role in hospital practice, and if so, whether clinical benefit outweighs impact on the overall blood supply; whether the logistic advantages of lyophilized plasma are accompanied by patient-outcome benefits; whether a viscoelastic-guided approach to transfusion management confers patient benefit; and whether prioritizing platelet transfusion (in one of the various forms available) reduces bleeding and mortality. Randomized trials of all these interventions have almost universally not confirmed plausible benefits hypothesized on the basis of pathophysiological rationale. The explanation most likely lies with the challenge of influencing long-term outcomes with an intervention lasting minutes when so many other factors intervene in the following months—analogous to listening for a faint noise in a snowstorm. New approaches to trial design, such as seeking short-term outcomes through adaptive designs using Bayesian analysis, promise to address this problem." @default.
- W4360920120 created "2023-03-26" @default.
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- W4360920120 date "2023-01-01" @default.
- W4360920120 modified "2023-10-14" @default.
- W4360920120 title "The Most Important Questions in the Current Practice of Transfusion of Critically Bleeding Patients" @default.
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- W4360920120 doi "https://doi.org/10.1007/978-3-031-23005-9_25" @default.
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