Procedures and Coagulopathy

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

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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