Procedures in patients with coagulopathies

Paracentesis

• Coagulation studies are NOT required before performance of the procedure
  • 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

• Tranfuse if platelets <50,000 or INR >1.4
• If hemophiliac, replace factor before LP

Central Line

• No benefit FFP if artery isn't hit
• Consider transfuse if plat <50,000
• Use compressible site if coagulopathic (jury is still out)

See Also

• Coagulopathy (Main)

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)