What is the use of Tegaderm (polyurethane film dressing) in the Intensive Care Unit (ICU) to prevent bleeding?

From the Guidelines

The use of ROTEM in ICU to prevent bleeding is not supported by the provided evidence, as it focuses on central venous catheters and thrombosis prevention, rather than coagulation management. However, in the context of preventing bleeding in ICU settings, point-of-care viscoelastic hemostatic assays like ROTEM are valuable tools. When implementing ROTEM in the ICU, clinicians should obtain baseline measurements for high-risk patients and repeat testing after significant blood loss or during active bleeding, as suggested by 1. The results guide specific interventions, such as:

• For prolonged clotting time, consider fresh frozen plasma or prothrombin complex concentrate,
• For decreased clot strength, administer platelets, cryoprecipitate, or fibrinogen concentrate,
• For increased fibrinolysis, consider tranexamic acid. Some key points to consider when using ROTEM include:
• The importance of baseline measurements for high-risk patients
• The need for targeted interventions based on ROTEM results
• The potential for ROTEM-guided therapy to reduce unnecessary blood product transfusions and improve patient outcomes, as seen in studies using similar viscoelastic assays 1. It is essential to note that the provided evidence does not directly address the use of ROTEM in ICU settings for bleeding prevention, but rather focuses on central venous catheters and thrombosis prevention. Therefore, the recommendation to use ROTEM in ICU settings is based on the general principles of coagulation management and the potential benefits of viscoelastic assays in guiding targeted interventions. In clinical practice, the use of ROTEM should be considered in the context of individual patient needs and the availability of evidence supporting its use in specific clinical scenarios.

From the Research

Use of Tranexamic Acid in ICU to Prevent Bleeding

• Tranexamic acid is an antifibrinolytic drug that reduces bleeding but may expose patients to a risk of thrombosis 2.
• It is used for the treatment of various types of bleeding, including menorrhagia, haematuria, certain surgical procedures, and trauma 2, 3.
• The harm-benefit balance of tranexamic acid is favourable in severe traumatic bleeding, but when bleeding is not life-threatening, the thrombotic risk is too poorly documented to justify exposing patients to a plausible and inadequately evaluated risk 2.
• Tranexamic acid significantly reduces blood loss in a wide range of surgical procedures and improves survival rates in obstetric and trauma patients with severe bleeding 4.
• The administration of high doses of tranexamic acid has been associated with seizures and other adverse effects, and the administration of tranexamic acid to reduce perioperative bleeding needs to be standardized 4.

Dosage and Administration

• Tranexamic acid concentrations between 10 and 15 mg/l resulted in substantial inhibition of fibrinolysis, although concentrations between 5 and 10 mg/l were partly inhibitory 5.
• The European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results 6.

Safety and Efficacy

• Tranexamic acid is generally well tolerated, and most adverse reactions are considered mild or moderate 4.
• Severe events are rare in clinical trials, and literature reviews have shown tranexamic acid to be safe in several different surgical procedures 4.
• However, the use of tranexamic acid in severely injured patients may not always be appropriate, and its use should be carefully considered in each individual case 6.