View source for Procedures in patients with coagulopathies

==Background==
*Evidence is mostly retrospective studies or case reports
*Clinical practice should account for totality of circumstances, including operator experience

==[[Central line|Central Line]]==
{{Central line with coagulopathy}}

==[[Lumbar Puncture]]==
{{Lumbar puncture with coagulopathy}}

==[[Paracentesis]]==
{{Paracentesis if coagulopathic}}

==[[Thoracentesis]]==
{{Thoracentesis with coagulopathy}}

==Specific Populations==
===Cirrhosis<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>===
*INR is a poor marker of coagulation in [[cirrhosis]]
*Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics
*Each 100 cc infusion of plasma increases portal venous pressure by 1 mmHg (normal pressure 5-10 mmHg)
*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion
**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
**Do not use PT/INR to risk stratify liver disease patients
**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL

==See Also==
*[[Coagulopathy (Main)]]

==External Links==
*http://www.sirweb.org/clinical/cpg/4E8CAd01.pdf

==References==
<references/>

[[Category:Procedures]]
[[Category:Heme/Onc]]