Current perioperative guidelines and monitoring strategies for paediatric coagulopathy lack valid age-specific reference values and rely on expert consensus due to an absence of prospective data.
Current perioperative bleeding management in pediatric patients relies heavily on expert consensus due to a lack of adequately powered prospective studies and age-specific reference values for dynamic monitoring.
Neonates, infants, and children undergoing major surgery or with trauma can develop severe coagulopathy perioperatively. Neonates and infants are at highest risk because their haemostatic system is not fully developed and underlying inherited bleeding disorders may not have been diagnosed before surgery. Historically, laboratory coagulation measurements have been used to diagnose and monitor coagulopathies. Contemporary dynamic monitoring strategies are evolving. Viscoelastic testing is increasingly being used to monitor coagulopathy, particularly in procedures with a high risk of bleeding. However, there is a lack of valid age-specific reference values for diagnosis and trigger or target values for appropriate therapeutic management. A promising screening tool of primary haemostasis that may be used to diagnose quantitative and qualitative platelet abnormalities is the in vitro closure time by platelet function analyser. Targeted individualised treatment strategies for haemostatic bleeding arising from inherited or acquired bleeding disorders may include measures such as tranexamic acid, administration of plasma, derived or recombinant factors such as fibrinogen concentrate, or allogeneic blood component transfusions (plasma, platelets, or cryoprecipitate). Herein we review current recommended perioperative guidelines, monitoring strategies, and treatment modalities for the paediatric patient with a coagulopathy. In the absence of data from adequately powered prospective studies, it is recommended that expert consensus be considered until additional research and validation of goal-directed perioperative bleeding management in paediatric patients is available.
Erdoes et al. (Mon,) conducted a review in Congenital and acquired coagulopathy. Perioperative guidelines, monitoring strategies, and treatment modalities was evaluated. Current perioperative guidelines and monitoring strategies for paediatric coagulopathy lack valid age-specific reference values and rely on expert consensus due to an absence of prospective data.