Emerging haemostatic agents and patient blood management

The transfusion of allogeneic blood products has been considered as a life-saving procedure for patients suffering from major traumatic injury and those who are undergoing major surgery. The safety of blood products has improved in terms of infectious complications over the last three decades due to advanced donor screening procedures and tests. Nevertheless, non-infectious complications including a blood-type mismatch, volume overload and immunologic and non-immunologic reactions to blood products can adversely affect clinical outcomes. It is thus important to implement a patient-specific strategy in diagnosing bleeding cause(s) and optimising haemostatic therapy. This strategy is an integral part of patient blood management applicable to many perioperative patients. Recent advances in the haemostatic management and transfusion include better understanding of the pathomechanisms of coagulopathy, availability of point-of-care coagulation monitoring and introductions of pathogen-inactivated plasma and factor concentrates as well as recombinant coagulation factors. Understanding the indications and limitations of conventional haemostatic therapy, and potential indications and complications relating to emerging haemostatic agents, is important for perioperative physicians. In this article, we discuss current issues related to allogeneic plasma products and emerging biological haemostatic agents and techniques. Further, we review the mechanisms of action and available preclinical or clinical data for each therapeutic agent.