General Critical Care

Pharmacotherapy for Reducing RBC Transfusion for Patients in... : Critical Care Medicine (lww.com)

This systematic review and network meta-analysis in Critical Care Medicine (April 2024) assessed therapies to reduce RBC transfusion needs in ICU patients. Searching MEDLINE, CENTRAL, and Embase until July 2023, it included 75 studies with 15,091 patients. Combination therapy of erythropoiesis-stimulating agents (Epo) and iron was found to notably decrease transfusion requirements (RR: 0.60; moderate confidence), outperforming Epo or iron monotherapy (RR: 0.81 and 0.83; low confidence, respectively). No significant increase in venous thromboembolism or infection risks was associated with combination therapy. In contrast, Epo alone might increase infection risks. The efficacy of vitamin D3 and HIF-PHI remains unclear.

In Disseminated Intravascular Coagulation (DIC), patients may present with both necrotic and hemorrhagic skin lesions, reflecting the complex and severe nature of this condition. The necrotic lesions arise from widespread microthrombi formation in small blood vessels, leading to impaired blood flow and subsequent tissue death, manifesting as purplish, black, or red patches on the skin. Concurrently, hemorrhagic lesions occur due to the significant depletion of platelets and clotting factors, a result of the excessive clotting process, leading to spontaneous bleeding under the skin. These may appear as petechiae, purpura, or ecchymoses, scattered across various parts of the body.

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This study examines the effectiveness and safety of Prothrombin Complex Concentrate (PCC) in treating trauma-induced coagulopathy (TIC) in adult trauma patients. Utilizing a systematic review of MEDLINE and EMBASE databases, the study included nine observational studies and one randomized controlled trial (RCT), covering 1150 patients treated with PCC. The main outcomes were in-hospital mortality and venous thromboembolism (VTE). The results, which combined observational studies and the RCT, indicated that PCC use did not significantly impact mortality rates (odds ratio 0.94) or the risk of deep venous thrombosis (odds ratio 1.00).

For specialists in the trauma field, these findings are significant. They suggest that while PCC does not increase VTE risk, its effectiveness in reducing mortality in TIC patients remains unproven. This uncertainty underscores the need for further comprehensive studies, particularly RCTs, to better understand PCC’s role in trauma care and guide clinical decision-making.

Severe ARDS secondary to COVID-19. CRRT clotted immediately and the above clot was removed from the circuit!

A systematic review and meta-analysis were undertaken to assess the implications of perioperative red blood cell transfusion on postoperative outcomes following elective major abdominal surgery. Publications from January 1, 2000, to June 6, 2020, in the PubMed, Cochrane, and Scopus databases were meticulously evaluated. Although no randomized controlled trials emerged, out of the 39 observational studies identified, 37 were integrated into the meta-analysis.

Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis

Individuals on single or combined antithrombotic therapy with high or very high cardiovascular risk have an elevated susceptibility to severe infections and related complications, both in the short and long term. When infection and sepsis is associated with coagulopathy, adjustments to antithrombotic therapy is often necessary based on underlying cardiovascular conditions, treatment indications, clinical status, and patient prognosis:

• If the platelet count falls below 100 × 10^9/L in patients already on oral anticoagulation (OAC), heparins should be utilized; heparins should be discontinued if the platelet count drops below 30 × 10^9/L.