Study: NCT03784794

Intervention type: DIAGNOSTIC_TEST
Group type: EXPERIMENTAL
Intervention: Thromboelastometry
Description: devices generate output by transducing changes in the viscoelastic strength of a small sample of clotting blood (300 µl) to which a constant rotational force is applied. These point of care devices allow visual assessment of blood coagulation from clot formation, through propagation, and stabilization, until clot dissolution. Computer analysis of the output allows sophisticated clot formation/dissolution kinetics and clot strength data to be generated

Intervention type: DIAGNOSTIC_TEST
Group type: ACTIVE_COMPARATOR
Intervention: Standard Coagulation Test
Description: coagulation tests, such as the prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT), to assess blood clotting function in patients. Clauss Fibrinogen.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Fibrinogen Concentrate Human
Description: To treat acquired fribinogen deficiency investigators will treat with the following doses FIBTEM A5 = 9-11 MM a 2 G FIBRINOGEN CONC. (25 MG/KG); FIBTEM A5 = 4-8 MM a 4 G FIBRINOGEN CONC. (50 MG/KG); FIBTEM A5 \< 4 MM a 6 G FIBRINOGEN CONC. (75 MG/KG)

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Prothrombin Complex Concentrates
Description: to treat acquired factor deficiency investigators will treat as follows PROTROMBIN COMPLEX CONCENTRATE EXTEM CT \> 80 SEC AND FIBTEM A5 ≥ 8 MM 4F-PCC 20 IU/KG (F II, VII, IX and X) GOAL: EXTEM CT ≤ 80 SEC

Intervention type: OTHER
Group type: ACTIVE_COMPARATOR
Intervention: Platelets
Description: PLATELETS EXTEM A5 \< 40 MM AND FIBTEM A5 ≥ 12 MM EXTEM A5 \< 40 MM → 1 PLATELET POOL OR APHERESIS; EXTEM A5 \< 30 MM → 2 PLATELET POOL OR APHERESIS GOAL: EXTEM A5: 40-50 MM or PLATELET COUNT \< 100/µL PLT \< 100/µL → 1 PLATELET POOL OR APHERESIS; PLT \> 50/µL → 2 PLATELET POOL OR APHERESIS GOAL: PLT COUNT \> 100/µL

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Platelets
Description: PLATELETS EXTEM A5 \< 40 MM AND FIBTEM A5 ≥ 12 MM EXTEM A5 \< 40 MM → 1 PLATELET POOL OR APHERESIS; EXTEM A5 \< 30 MM → 2 PLATELET POOL OR APHERESIS GOAL: EXTEM A5: 40-50 MM or PLATELET COUNT \< 100/µL PLT \< 100/µL → 1 PLATELET POOL OR APHERESIS; PLT \> 50/µL → 2 PLATELET POOL OR APHERESIS GOAL: PLT COUNT \> 100/µL

Intervention type: OTHER
Group type: ACTIVE_COMPARATOR
Intervention: Red Blood Cells
Description: Transfuce Red Blood Cells if Hemoglobine levels \< 7 G/DL;~1 unit of FFP for every unit of RBC Transfused GOAL: Hb \> 7.5 G/DL

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Red Blood Cells
Description: Transfuce Red Blood Cells if Hemoglobine levels \< 7 G/DL;~1 unit of FFP for every unit of RBC Transfused GOAL: Hb \> 7.5 G/DL

Intervention type: OTHER
Group type: ACTIVE_COMPARATOR
Intervention: Fresh Frozen Plasma
Description: FRESH FROZEN PLASMA TP AND/OR TTP PATHOLOGICAL INR, 2.0-4.0 → FFP 20 ML/KG GOAL: TP AND TTP NORMAL AND INR \< 2.0

Intervention type: OTHER
Group type: ACTIVE_COMPARATOR
Intervention: cryoprecipitates
Description: FIBRINOGEN (CLAUSS) \< 250 MG/DL FIB 200-250 MG/DL → CRYOS, PACK OF 10 (25 MG/KG); FIB 100-200 MG/DL → CRYOS, PACK OF 20 (50 MG/KG); FIB \< 100 MG/DL → CRYOS, PACK OF 30 (75 MG/KG) GOAL: FIB \> 250 MG/DL