COAGULOPATHY IN THE CRITICALLY ILL PATIENT: TRANSFUSION STRATEGIES BASED ON ADVANCED HEMOSTATIC MONITORING AND THERAPY

Abstract

Coagulopathy in critically ill patients is a complex and multifactorial condition associated with high morbidity and mortality in intensive care units. This study aimed to analyze the scientific evidence published between 2021 and 2025 regarding transfusion strategies based on advanced hemostatic monitoring and targeted therapy. This is a systematic review conducted according to PRISMA recommendations, with searches in the PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and LILACS databases. Clinical trials, observational studies, systematic reviews, and guidelines addressing coagulopathy in critically ill adult patients were included, with an emphasis on the use of viscoelastic tests, such as thromboelastography and rotational thromboelastometry. The results showed that coagulopathy in contexts such as trauma, sepsis, and liver failure involves dynamic alterations in coagulation, characterized by an imbalance between bleeding and thrombosis. Advanced hemostatic monitoring demonstrated superiority over conventional tests by allowing a comprehensive and real-time assessment of clot formation and stability. Goal-directed protocols have been shown to be associated with reduced empirical use of blood components, lower incidence of transfusion complications, and potential improvement in clinical outcomes. Restrictive and individualized transfusion strategies, integrated with clinical and multidisciplinary assessment, stood out as a safer and more effective approach. It is concluded that the incorporation of viscoelastic methods into clinical practice represents a significant advance in the management of coagulopathy in critically ill patients, favoring targeted interventions, transfusion rationalization, and optimization of clinical results.