Fixed ratio versus goal-directed therapy in trauma

Area of Science:

• Transfusion Medicine
• Coagulation Disorders
• Trauma Care

Background:

• Fixed ratios of plasma and platelets to red blood cells are used to manage trauma-induced coagulopathy.
• Storage time impacts the efficacy of transfusion products, and no universal standard exists.
• Individualized goal-directed coagulation therapy (GDCT) is emerging in trauma care.

Purpose of the Study:

• To compare fixed ratio transfusion strategies with individualized goal-directed coagulation therapy (GDCT).
• To evaluate the role of point-of-care viscoelastic tests (VETs) in guiding coagulation therapy.

Main Methods:

• Review of current data on transfusion strategies.
• Description of GDCT principles and its application in trauma patients.
• Emphasis on the use of viscoelastic tests (VETs) for diagnosis and targeted therapy.

Main Results:

• Early, high ratios of plasma and platelets to red blood cells are associated with improved outcomes.
• VETs provide rapid information on hemostatic deficiencies, enabling tailored treatment.
• Treatment algorithms for coagulation factor concentrates, plasma, and platelets based on VET results have been established.

Conclusions:

• Individualized GDCT guided by VET offers potential advantages over fixed ratio therapy.
• Further research directly comparing these hemostatic strategies is necessary.