Procedures in patients with coagulopathies
Background
- Evidence is mostly retrospective studies or case reports
- Clinical practice should account for totality of circumstances, including operator experience
Central Line
Central line if coagulopathic
- 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]
Lumbar Puncture
Lumbar puncture if coagulopathic
- Tranfuse if platelets <25,000[3][4]
- INR >1.5
- Hemophilia, von Willebrand disease, other coagulopathies
- If hemophiliac, replace factor before LP
Paracentesis
Paracentesis if coagulopathic
- 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
Thoracentesis
Thoracentesis if coagulopathic
See Also
Further Reading
- Indravadan P. et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. J Vasc Interv Radiol 2012 PDF
References
- ↑ 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