Coagulopathy (main): Difference between revisions

Latest revision as of 18:15, 17 February 2021

Background

Primary hemostasis: damage to endothelial basement membrane and formation of platelet plug
Secondary hemostasis: coagulation cascade

Coagulation cascade

Clinical Features

Spontaneous bleeding
Bleeding out of proportion
Swollen joints
Epistaxis
Bleeding gums
Menometrorrhagia
Easy bruising/petechiae
Hematuria

Differential Diagnosis

Coagulopathy

Platelet Related

Too few
- Thrombocytopenia
Nonfunctional
- Aspirin
- Von Willebrand disease

Factor Related

Acquired (Drug Related)
- Warfarin (Coumadin)
- Unfractionated heparin
- Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
- Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
- Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
Illness induced
Genetic

Increased Clotting

Management

References

Authors:

@@ Line 1: / Line 1: @@
-==Liver Disease==
+==Background==
-===Background===
+*Primary hemostasis: damage to endothelial basement membrane and formation of platelet plug
-*PT prolongation
+*Secondary hemostasis: coagulation cascade
-**Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X)
+[[File:Coagulation cascade.png|thumbnail|Coagulation cascade]]
-*Thrombocytopenia
-**Portal hypertension -> congestive hypersplenism -> splenic sequestration
-*Fibrinolysis increased
-**Due to decreased synthesis of alpha2 plasmin inhibitor
-**Low fibrinogen level, mild elevation of FDP and D-dimer
-===Treatment===
+==Clinical Features==
-#Lab abnormalities only (w/o significant bleeding)
+*Spontaneous [[hemorrhage|bleeding]]
-##Observation
+*Bleeding out of proportion
-#Significant bleeding
+*Swollen joints
-##Vitamin K PO or IV
+*[[Epistaxis]]
-##Desmopressin
+*Bleeding gums
-###Effective w/ minimal side effects
+*[[vaginal Bleed Non-Pregnant|Menometrorrhagia]]
-###0.3 mg/kg IV (preferred) or SC (max 20mg)
+*Easy bruising/[[petechiae]]
-###Onset of action ~1hr, duration of action ~4-24hr
+*[[Hematuria]]
-##Cryoprecipitate
-###May be used to replace fibrinogen in pts w/ fibrinogen levels <100
-###1 bag per 10kg of body weight
-##Plts
-###Aim for >50K for moderate risk procedures; >100K for high risk procedures
-##FFP
-###Use w/ caution; requires large volume of FFP to make a significant difference
-##PPI/pepcid/octreotide (variceal bleed)
-==Renal Disease==
+==Differential Diagnosis==
-===Background===
+{{Increased bleeding DDX}}
-*Uremic toxins inhibit platelet aggregation
-*Dialysis may induce thrombocytopenia
-===Treatment===
+===Increased Clotting===
-#Acute dialysis
+{{Increased clotting DDX}}
-##pRBCs
-###Raising hct to above 25-30% improves bleeding time
-##Desmopressin
-###Simplest and least toxic acute treatment
-###Increases release of factor VIII:von Willebrand factor multimers
-###0.3 mg/kg IV (preferred) or SC (max 20mg)
-###Onset of action ~1hr, duration of action ~4-24hr
-#Estrogen
-##Unclear mechanism of action
-##Onset of action within 1d
-##Options
-###Conjugated estrogen 0.6mg/kg IV or 2.5-25mg PO daily
-#Cryoprecipitate
-##Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion
-#Plt transfusion
-##Minimally effective b/c infused plts quickly acquire the uremic defect
+==Management==
+*[[Bleeding Treatments]]
+*[[Procedures in patients with coagulopathies]]
+*[[Anticoagulant reversal]] (known medications)
+**[[Warfarin (Coumadin) Reversal]]
+**[[Dabigatran (Pradaxa) Reversal]]
+**[[Rivaroxaban reversal]]
+**[[Unfractionated heparin reversal]]
+*[[Anti-platelet agent reversal]]
-==Source==
+==See Also==
-*Tintinalli
+*[[Transfusions]]
-*UpToDate
+*[[Idarucizumab]]
+*[[Procedures in patients with coagulopathies]]
+==References==
+<references/>
 [[Category:Heme/Onc]]