Clinical aspects of coagulation and haemorrhage

Haemostasis is a complex physiological cascade that results in cessation of bleeding following injury. Inherited bleeding diatheses and hypercoagulable diseases remain a source of patient morbidity that should be recognized and managed. Liver disease should be seen as a heterogeneous group of disorders with unpredictable coagulation effects. The CRASH II trial, recent recommendation by the European Medicines Agency for re-licensing of Trasylol (aprotinin) and the increasing use of novel antiplatelet agents reflect the rapidly evolving haemostatic landscape. Empirical strategies for managing coagulopathy of any aetiology look increasingly flawed as the technology required to tailor therapy to individual situations is now widely available at the point of care.