Procedures and Coagulopathy
This page is due for revision.
OVERVIEW
- many procedures are contra-indicated in the presence of coagulopathy
- the degree of acceptable coagulopathy for different procedures is controversial
RECOMMENDED PLATELET COUNTS AND INR LEVELS
Platelets ≥50,000 and INR ≤1.5
- Lumbar Puncture
- Thoracentesis
- Transbronchial Lung Biopsy
- Renal Biopsy
- Liver Biopsy
- Hickmann and Groshong Catheters
Platelets ≥30,000 and INR ≤1.5
- Subclavian or IJ Line
Platelets ≥30,000 and INR ≤2.0
- Paracentesis
OTHER INFORMATION
- Conditions that may affect platelet function include renal failure, medications (e.g. aspirin, NSAIDs, clopidogrel, dipyridamole), leukemias and myelodysplasias, and congenital disorders
- Bleeding Time is a poor predictor of surgical bleeding
- The utility if Platelet Function Analysis (PFA) in predicting surgical bleeding is uncertain
References and links
CCC Transfusion Series
Blood Products: Cryoprecipitate, Fresh Frozen Plasma (FFP), Platelets, Red Cells (RBCs)
>>> Factor Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate
Reversal Agents:
>>> Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding
>>> Dabigatran: Idarucuzimab, Dabigatran and bleeding
>>> Heparin: Protamine
>>> Warfarin: Vitamin K, FFP, PTx, Warfarin Refersal, Warfarin Toxicity
Testing: Coagulation Studies, TEG / ROTEM (Thromboelastography), Platelet function assays
Conditions: Acute Coagulopathy of Trauma, Disseminated Intravascular Coagulation (DIC), Massive Blood Loss
General Topics: Blood Bank, Blood Conservation Strategies, Blood Product Compatibilities, Blood Transfusion Risks, Massive Transfusion Protocol (MTP), Modifications to Blood Components, Procedures and Coagulopathy, Storage Lesions, TRALI, Transfusion Literature, Transfusion Reactions
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC