Perioperative factor concentrate therapy

Transfusion of allogeneic plasma has been a life-saving measure for decades in patients with severe trauma or suffering from major surgical blood loss. The safety of allogeneic blood components has improved in terms of pathogen transmission, but haemostatic efficacy of plasma is hindered by the large volume and time required for thawing and infusion. Several plasma-derived and recombinant factor concentrates are clinically available and indicated for targeted replacement of missing coagulation elements in hereditary disorders of thrombosis and haemostasis. When used appropriately, factor concentrate therapy can rapidly restore deficient factor(s) without causing volume overload. The haemostatic defect in perioperative patients is often multifactorial, and therefore careful clinical judgement and timely coagulation testing must be exercised before the administration of factor concentrates. In this review, the rationale for including factor concentrates in perioperative haemostatic management will be discussed in conjunction with the limitations of plasma transfusion.