Nationwide expert survey on transfusion and coagulation management strategies for bleeding critically ill patients in China
Year: 2025
Type: article
Study design: Observational Study
Abstract: This study aimed to investigate coagulation management strategies by experienced critical care physicians across China. The questionnaire was independently designed referencing current guidelines and literature, and refined through five rounds of multidisciplinary review, covering basic information, blood product supply, clinical practices, and laboratory support. The survey recruited 473 senior physicians from 473 Intensive Care Units (ICUs) at 431 tertiary hospitals across China. Many hospitals reported a shortage of blood products. Most physicians preferred a strategy of fixed ratio for transfusion in traumatic (350/473, 74.0 %) and non-traumatic (271/473, 57.29 %) massive hemorrhage. For patients with hemorrhage and coagulopathy, fresh frozen plasma (FFP) (421/473, 89.0 %), prothrombin complex concentrate (PCC) (274/473, 57.9 %), and cryoprecipitate (Cryo) (213/473, 45.0 %) were commonly used. In cases of massive hemorrhage, 39.7 % (188/473) of physicians would empirically administer PCC, and 77.6 % (367/473) would rely on the results of traditional laboratory tests. Human fibrinogen (FIB) concentrate (373/473, 78.9 %) and Cryo (380/473, 80.3 %) were commonly used to replenish fibrinogen. To raise plasma FIB levels, 1-2 g of FIB (352/473, 74.4 %) and 5-15 units (U) of Cryo (402/473, 84.99 %) were usually administered empirically; a FIB level above 2.0 g/L was the most commonly used standard for treatment termination (234/473, 49.5 %). Tranexamic acid (TXA) was commonly used to treat traumatic (338/473, 71.5 %) or non-traumatic (326/473, 68.9 %) intracranial hemorrhage. Significant variation was observed in the use of FFP (351/473, 74.2 %) and PCC (171/473, 36.2 %) to treat hemorrhage caused by vitamin K antagonists. Significant differences have been observed in blood product supply and treatment strategies used by ICU physicians for massive hemorrhage in critically ill patients, suggesting the need for treatment protocol standardization and further research. KEYPOINTS: This nationwide expert survey provides a comprehensive understanding of current clinical practices in blood product transfusion and coagulation management for critically ill patients with hemorrhage. Most hospitals encounter a shortage of blood products while treating massive hemorrhage. Blood product transfusion ratios, plasma transfusion strategies, and PLT transfusion indications are notably different when treating critically ill patients with massive versus non-massive hemorrhage. Practical variations exist regarding the threshold indications and dosing of PCC, FIB, Cryo, and TXA in the setting of hemorrhage. Discrepancy and knowledge gaps still exist in antithrombotic reversal strategy for vitamin K antagonists, novel oral anticoagulant (NOAC), and antiplatelet drug-induced hemorrhage.
Source: Journal of Critical Care
Authors: Siying Chen, Lu Xu, Shiyu Liu, Bingkui Ren, Yuping Zhang, Junci Chong, Lu Ke, Jingchun Song, Yun Fan, Chuanbao Li, Junhua Hu, Huanzhang Shao, Chao Deng, Xiaojun Yang, Haiyan Wu, You Shang, Yuanqi Gong, Feng Guo, Daozheng Huang, Zhiyong Liu, Lei Li, Cunrong Chen, Junwei Zhang, Haiying Wu, Dong Zhang, Zhaoxia Yu, Zhengying Jiang, Yun Sun, Weidong Wu, Bin Li, Zhai Huang, Xiaoyun Fu, Jingyao Zhang, Xuelian Liao, Lihua Zhou, Changsong Wang, Renyu Ding, Lin Dou, Xuexia Xu, Huiying Zhao, Zhigang Chang
Institutions: Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Hospital, Peking University People's Hospital, Nanjing General Hospital of Nanjing Military Command, Nanjing University, Chinese People's Liberation Army, Henan University, Henan Provincial People's Hospital, Central South University, Ningxia Medical University, Qingdao University, Kunming Medical University, First Affiliated Hospital of Kunming Medical University, Taian City Central Hospital, Wuhan Union Hospital, Huazhong University of Science and Technology, Second Affiliated Hospital of Nanchang University, Sir Run Run Shaw Hospital, Zhejiang University, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Xiangya Hospital Central South University, Shanghai Jiao Tong University, Ruijin Hospital, Fujian Medical University, Union Hospital, Second Hospital of Tangshan, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, First Hospital of Jilin University, First Affiliated Hospital of Xinjiang Medical University, Chongqing University, Chongqing Cancer Hospital, Anhui Medical University, Second Affiliated Hospital of Anhui Medical University, First Hospital of Lanzhou University, The People's Hospital of Guangxi Zhuang Autonomous Region, Zunyi Medical University, Sichuan University, West China Hospital of Sichuan University, Inner Mongolia Medical University, First Affiliated Hospital of Harbin Medical University, First Hospital of China Medical University, China Medical University, Tianjin First Center Hospital, Qinghai Provincial Peoples Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,610
Awards: G3391958918, G6007313682
OpenAlex ID: W4416239278