Early recognition of coagulopathy is necessary for its prompt correction and successful management. Novel approaches, such as point-of-care testing (POC) and administration of
coagulation factor concentrates (CFCs), aim to tailor the haemostatic
therapy to each patient and thus reduce the risks of over- or under-transfusion. CFCs are an effective alternative to ratio-based transfusion
therapies for the correction of different types of coagulopathies. In case of major
bleeding or urgent surgery in patients treated with
vitamin K antagonist
anticoagulants,
prothrombin complex concentrate (PCC) can effectively reverse the effects of the
anticoagulant drug. Evidence for PCC effectiveness in the treatment of direct oral
anticoagulants-associated
bleeding is also increasing and PCC is recommended in guidelines as an alternative to specific reversal agents. In
trauma-induced coagulopathy,
fibrinogen concentrate is the preferred first-line treatment for hypofibrinogenaemia. Goal-directed coagulation management algorithms based on POC results provide guidance on how to adjust the treatment to the needs of the patient. When POC is not available, concentrate-based management can be guided by other parameters, such as blood gas analysis, thus providing an important alternative. Overall, tailored haemostatic
therapies offer a more targeted approach to increase the concentration of
coagulation factors in
bleeding patients than traditional transfusion protocols.