Procedures in patients with coagulopathies: Difference between revisions
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==Thoracentesis== | ==Thoracentesis== | ||
*Consider transfusion if platelets <50,000, or if PT/PTT twice the normal range <ref>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</ref> | *Consider transfusion of platelets if platelets <50,000, or Fresh Frozen Plasma if PT/PTT twice the normal range <ref>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</ref> | ||
==Lumbar Puncture== | ==Lumbar Puncture== | ||
Revision as of 14:40, 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
- Consider transfusion of platelets if platelets <50,000, or Fresh Frozen Plasma if PT/PTT twice the normal range [2]
Lumbar Puncture
Central Line
- No benefit FFP if artery isn't hit[6]
- 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
- ↑ 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
- ↑ 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