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 | *Coagulation studies are NOT required before performance of the procedure<ref>Wilkerson, Annals of Emerg Med, 2009</ref> | ||
*routine use of FFP and platelets is not recommended | **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 | *contraindicated only if DIC or fibrinolysis | ||
*incidence of clinically significant bleeding complications low even in liver failure (< 0.2%) | *incidence of clinically significant bleeding complications low even in liver failure (< 0.2%) | ||
Revision as of 04:27, 3 July 2014
Paracentesis
- Coagulation studies are NOT required before performance of the procedure[1]
- 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
Central Line
- No benefit FFP if artery isn't hit[5]
- Consider transfuse if plat <50,000
- Use compressible site if coagulopathic (jury is still out)
See Also
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)
- ↑ Wilkerson, Annals of Emerg Med, 2009
- ↑ Roberts, Clin Proc Emer Med 2004
- ↑ Johnson KS, et al. Lumbar puncture: Technique, indications, contradindications, and complications in adults. Sept 18, 2013. UpToDate.
- ↑ Johnson KS, et al. Lumbar puncture: Technique, indications, contradindications, and complications in adults. Sept 18, 2013. UpToDate.
- ↑ Am J Surg '01