Hemostasis and blood transfusion: randomized trials 2023: 616.411-003.971

Abstract

Summary. Introduction. The results of randomized controlled trials (RCT) are becoming an increasingly important source of clinical recommendations in transfusion medicine. Aim: to study the results of RCT in the field of transfusion correction of hemostasis disorders, published in 2023. Materials and Methods. A search was conducted using the words in Russian and English “hemostasis”, “blood transfusion”, “coagulopathy” in electronic libraries of Russia (eLibrary.ru) and the USA (pubmed.ncbi.nlm.nih.gov) with filters “RCT” (English only) and “within a year”. Results. In 2023, the RCT established the following facts: 1) the lack of effectiveness of early and empirical addition of high doses of cryoprecipitate to the standard treatment of severe injuries; 2) the effectiveness of prophylactic platelet transfusion before insertion of a central venous catheter in patients with platelet count (10–50)×109/L; 3) in trauma patients at risk of massive transfusion, there is no reduction in 24-hour blood product consumption after administration of prothrombin complex concentrate (PCC) but an increased risk of thromboembolic events; 4) among adults with major trauma and suspected coagulopathy who were treated in intensive care systems, prehospital administration of tranexamic acid followed by an 8-hour infusion did not increase the proportion of surviving patients with a favorable functional outcome after 6 months; 5) there is no difference in the effect of liberal or restrictive blood transfusion strategies on platelet reactivity and biomarkers of thrombosis and inflammation in patients with myocardial infarction and anemia. Conclusion. The above provisions will not affect the practice of prescribing blood components at the Pirogov National Medical and Surgical Center: a) indication for transfusion of 5 single units of cryoprecipitate is a bleeding in a patient with a fibrinogen concentration of less than 1 g/L; b) before a minimally invasive procedure, the platelet concentration should be more than 30×109/L, and the maximum amplitude of the thromboelastogram should be more than 46 mm; c) PCC and tranexamic acid are administered in accordance with the instructions for the drug; d) the target hemoglobin concentration in a patient with myocardial infarction is 100 g/L.

For citation: Zhiburt E.B., Shestakov E.A., Madzaev S.R., Shalygin L.D. Hemostasis and blood transfusion: randomized trials 2023. Tromboz, gemostaz i reologiya. 2024;(2):13–18. (In Russ.).

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