Procedures in patients with coagulopathies
Paracentesis
- 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 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)
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)
8/14/06 DONALDSON (adapted from Lampe, Charfen)