Procedures in patients with coagulopathies: Difference between revisions

Revision as of 07:55, 30 May 2015

All of the below rules are guidelines with mostly retrospective and case report evidence. All rules need to account for operator experience. The most experienced operator should perform the procedure.

Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible, though IJ preferred over subclavian)
No benefit to giving FFP unless artery is punctured^[1]
- However, consider giving FFP if patient has hemophilia^[2]

Tranfuse if platelets <25,000^[3]^[4]
INR >1.5
Hemophilia, von Willebrand disease, other coagulopathies
- If hemophiliac, replace factor before LP

Coagulation studies are NOT required before performance of the procedure^[5]
- Incidence of clinically significant bleeding complications is low even if in liver failure with an elevated INR (< 0.2%)^[6]
No data supports cutoff values beyond which paracentesis should be avoided/prophylactically transfused
Routine use of FFP and platelets is not recommended
Procedure is contraindicated if the patient is actively bleeding or in DIC

↑ Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
↑ Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556
↑ Howard SC, Gajjar A, Ribeiro RC, et al. Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. JAMA 2000; 284:2222–2224
↑ Vavricka SR, Walter RB, Irani S, Halter J, Schanz U. Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. Ann Hematol 2003; 82:570–573
↑ Wilkerson, Annals of Emerg Med, 2009
↑ Thomsen TW. Paracentesis. N Engl J Med 2006; 355: e21
↑ ^7.0 ^7.1 McVay P. et al. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion. 1991 Feb;31(2):164-71

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 ==[[Paracentesis]]==
-*Coagulation studies are NOT required before performance of the procedure<ref>Wilkerson, Annals of Emerg Med, 2009</ref>
+{{Paracentesis if coagulopathic}}
-*No data supports cutoff values beyond which paracent should be avoided/prophylactically transfused
-*Routine use of FFP and platelets is not recommended
-*Contraindicated if the patient is actively bleeding or in [[DIC]] and the incidence of clinically significant bleeding complications is low even if in liver failure with an elevated INR (< 0.2%)<ref>Thomsen TW. Paracentesis. N Engl J Med 2006; 355: e21</ref>
 ==[[Thoracentesis]]==