Procedures in patients with coagulopathies

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)