PubMed · 5687143
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F L Jordan. 1968-11-02. [Diffuse intravascular coagulation].. https://pubmed.ncbi.nlm.nih.gov/5687143/
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Inherited coagulation protein deficiencies associated with bleeding diatheses may present with spontaneous bleeding early in life, or may not be recognized until the development of hemorrhage after trauma or surgery. Diagnostic evaluation with coagulation screening tests, followed by confirmation with coagulation factor assays, is essential for appropriate management. For moderate-to-severe hemophilia, treatment includes coagulation factor replacement with purified, plasma-derived coagulation factor, or in the case of hemophilia A, factor VIII concentrate produced with recombinant techniques. Increased use of pharmacologic agents such as desmopressin acetate for patients with mild hemophilia A or type 1 von Willebrand's disease has allowed physicians to treat patients without the risk of infectious complications from plasma-derived factor concentrates. In addition to the management of the inherited bleeding disorders, patients may also require management of human immunodeficiency virus infection, hepatitis, and coagulation factor inhibitors. Issues for the coming years will include continued work to ensure product safety, the role of prophylactic treatment to prevent longterm disabilities, and the application of gene therapy to the management of bleeding disorders.
Virtually any medical complication can occur during the post-traumatic course of an individual patient with a severe head injury (SHI). Although recovery of an individual patient can be adversely influenced by any of these medical complications, only a few selected complications have been proven to be independent predictors of an unfavorable outcome. The most frequent medical complications in SHI patients include disturbances of serum electrolytes (60%) and blood coagulation (18%), pneumonia (40%), and septicemia (10%). Hypotension is also common, occurring both prehospital and inhospital at a frequency of 29% and 22%, respectively. These factors are statistically independent predictors of poor outcome in SHI patients. It has been suggested that elimination of these frequent complications might result in a 7.5% reduction of unfavorable outcome in this patient group.
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