Portuguese Consensus and Recommendations for Acquired Coagulopathic Bleeding Management (CCBM)

Area of Science:

• Hematology
• Clinical Practice Guidelines
• Evidence-Based Medicine

Background:

• Major bleeding management requires standardized protocols.
• Current practices among Portuguese physicians were not well-defined.
• Global recommendations are needed for clinical application.

Purpose of the Study:

• To assess Portuguese physicians' approaches to major bleeding.
• To develop evidence-based diagnostic and therapeutic recommendations.
• To establish a step-wise approach for clinical practice guidelines.

Main Methods:

• A three-step process involving a desk review, Delphi technique, and expert panel.
• A modified 3-round Delphi survey with 31 statements on a 5-point Likert scale.
• Consensus thresholds set at ≥90% (Round 1) and ≥85% (Rounds 2-3).

Main Results:

• Consensus was reached on 20/31 items (64.5%) in Round 1, 4/11 (36.4%) in Round 2, and 6/7 (85.7%) in Round 3.
• High consensus achieved on implementing Patient Blood Management, reducing allogeneic blood exposure, goal-directed therapies, and evaluating transfusion costs.
• One statement on clotting factor concentrates did not reach consensus.

Conclusions:

• Developed 12 evidence-based recommendations for bleeding coagulopathies management in Portugal using GRADE.
• Highlights the need for Patient Blood Management and cost-effectiveness studies in blood transfusions.
• Provides critically appraised, updated evidence for clinical practice.