Pro-hemostatic Therapy for Prevention and Treatment of Bleeding
The hemostatic system is able to swiftly convert fluid blood to a solid clot when there is a disruption of vascular integrity and bleeding occurs. Simultaneously, another important feature of hemostasis is to maintain blood fluidity within the blood vessel to guarantee adequate circulation throughout the body. These two paradoxical functions of the coagulation system can only be executed when, under physiological circumstances, there is a balance between low-level ongoing basal coagulation activation and permanent anticoagulation by both physiological anticoagulant mechanisms and fibrin removal as a function of the fibrinolytic system. Pharmacological agents may interfere in this balance, for example by inhibiting coagulant activity or promoting anticoagulant mechanisms, and indeed this type of treatment has proven to be effective in the prevention and treatment of thrombotic disease. Similarly, other agents are capable of promoting hemostasis or fibrin formation, or can block fibrinolytic activity. These so-called ‘pro-hemostatic agents’ may be useful in the prevention and treatment of bleeding in patients with coagulation defects, but also in patients with an a priori normal coagulation system, who experience severe (post-operative) bleeding or are to undergo procedures known to be associated with major blood loss . In this chapter, we will discuss the aims and potential risks of pro-hemostatic therapy, the various agents with a pro-hemostatic potential and the efficacy of pro-hemostatic drugs to reduce perioperative blood loss or treat excessive (postoperative) bleeding.
KeywordsCoagulation Factor Tranexamic Acid Massive Transfusion Coagulation Defect Primary Hemostasis
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- 2.Levi M, van der Poll T (2000) Hemostasis and coagulation. In: Norton JA, Bollinger RA, Chang AE, Lowry SF (eds) Surgery: Scientific Basis and Current Practice. Springer, New York, pp 161–176Google Scholar
- 3.Francis JL (1992) The use of drugs to reduce blood loss during surgery. Hematol Rev 7: 85–99.Google Scholar
- 4.Marder VJ, Butler FO, Barlow GH (1994) Antifibrinolytic therapy. In: Colman RW, Hirsh J, Marder VJ, Salzman EW (eds) Hemostasis and Thrombosis: Basic Principles and Clinical Practice. J.W. Lippincott, Philadelphia, pp 795–814Google Scholar
- 5.Edmunds LH, Salzman EW (1994) Hemostatic problems, transfusion therapy, and cardiopulmonary bypass in surgical patients. In: Colman RW, Hirsh J, Marder VJ, Salzman EW (eds) Hemostasis and Thrombosis: Basic Principles and Clinical Practice. J.W. Lippincott, Philadelphia, pp 1031–1045Google Scholar
- 11.Hedner U (1998) Recombinant activated factor VII as a universal haemostatic agent. Blood Coagul Fibrinolysis 9 (suppl 1): 5147–5152Google Scholar
- 17.Friederich PW, Geerdink MG, Spataro M, et al (2000) The effect of the administration of recombinant activated factor VII (NovoSeven) on perioperative blood loss in patients undergoing transabdominal retropubic prostatectomy: the PROSE study. Blood Coagul Fibrinolysis 11 (suppl 1): S129–132PubMedCrossRefGoogle Scholar
- 23.van der Meer J, Hillege HL, Kootstra GJ, et al (1993) Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands. Lancet 342: 257–264PubMedCrossRefGoogle Scholar
- 24.Lentschener C, Benhamou D, Mercier FJ (1997) Aprotinin reduces blood loss in patients undergoing elective liver resection. Anest Analg 84: 875–881Google Scholar