Procedures in patients with coagulopathies: Difference between revisions
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Revision as of 16:24, 9 June 2011
Paracentesis
no data supporting cutoff values for coags/platelets beyond which paracent should be avoided/prophylactically transfused
the routine use of fresh frozen plasma and platelet concentrates 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)