Procedures in patients with coagulopathies: Difference between revisions
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==Paracentesis== | ==Paracentesis== | ||
no data supporting cutoff values for coags/platelets beyond which paracent should be avoided/prophylactically transfused | *no data supporting cutoff values for coags/platelets beyond which paracent should be avoided/prophylactically transfused | ||
*routine use of FFP and platelets is not recommended | |||
*contraindicated only if DIC or fibrinolysis | |||
*incidence of clinically significant bleeding complications low even in liver failure (< 0.2%) | |||
contraindicated only if DIC or fibrinolysis | *Greatly increased serum creatinine levels --> consider post-procedure observation | ||
incidence of clinically significant bleeding complications low even in liver failure (< 0.2%) | |||
Greatly increased serum creatinine levels --> consider post-procedure observation | |||
==Thoracentesis== | ==Thoracentesis== | ||
Transfuse if plat <50,000, or PT/PTT twice nl range (Mcvay) | *Transfuse if plat <50,000, or PT/PTT twice nl range (Mcvay) | ||
==Lumbar Puncture== | ==Lumbar Puncture== | ||
Tranfuse if plat <50,000, or PT/PTT > 1.5 times nl | *Tranfuse if plat <50,000, or PT/PTT > 1.5 times nl | ||
*If hemophiliac, replace factor before LP | |||
If hemophiliac, replace factor before LP | |||
==Central Line== | ==Central Line== | ||
No benefit FFP if artery isn't hit (Am J Surg '01) | *No benefit FFP if artery isn't hit (Am J Surg '01) | ||
*Consider transfuse if plat <50,000 | |||
Consider transfuse if plat <50,000 | *Use compressible site if coagulopathic (jury is still out) | ||
Use compressible site if coagulopathic (jury is still out) | |||
==Sources== | ==Sources== | ||
Revision as of 23:22, 16 July 2012
Paracentesis
- no data supporting cutoff values for coags/platelets beyond which paracent should be avoided/prophylactically transfused
- routine use of FFP and platelets is not recommended
- contraindicated only if DIC or fibrinolysis
- incidence of clinically significant bleeding complications low even in liver failure (< 0.2%)
- Greatly increased serum creatinine levels --> consider post-procedure observation
Thoracentesis
- Transfuse if plat <50,000, or PT/PTT twice nl range (Mcvay)
Lumbar Puncture
- Tranfuse if plat <50,000, or PT/PTT > 1.5 times nl
- If hemophiliac, replace factor before LP
Central Line
- No benefit FFP if artery isn't hit (Am J Surg '01)
- Consider transfuse if plat <50,000
- Use compressible site if coagulopathic (jury is still out)
Sources
Paracentesis: Kaji Questions, Thomsen TW. Paracentesis. N Engl J Med 2006; 355: e21.; Roberts, Clin Proc Emer Med 2004; Yu (Clin Liv Dz '01)
8/14/06 DONALDSON (adapted from Lampe, Charfen)