Difference between revisions of "Coagulopathy (main)"

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==[[Renal Disease Induced Coagulopathy]]==
 
==[[Renal Disease Induced Coagulopathy]]==
===Background===
 
*Uremic toxins inhibit platelet aggregation
 
*Dialysis filter may cause thrombocytopenia
 
 
===Treatment===
 
#Acute dialysis
 
##pRBCs
 
###Raising hct to above 25-30% improves bleeding time
 
##Desmopressin
 
###Simplest and least toxic acute treatment
 
###Increases release of factor VIII:von Willebrand factor multimers
 
###0.3 mg/kg IV (preferred) or SC (max 20mg)
 
###Onset of action ~1hr, duration of action ~4-24hr
 
#Estrogen
 
##Unclear mechanism of action
 
##Onset of action within 1d
 
##Options
 
###Conjugated estrogen 0.6mg/kg IV or 2.5-25mg PO daily
 
#Cryoprecipitate
 
##Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion
 
#Plt transfusion
 
##Minimally effective b/c infused plts quickly acquire the uremic defect
 
  
 
==Managment==
 
==Managment==

Revision as of 13:26, 7 January 2014

DDX

Lupus Anticoagulant

  1. (rare)
  2. warfarin or ASA

Liver Disease Induced Coagulopathy

Background

  • PT prolongation
    • Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X)
  • Thrombocytopenia
    • Portal hypertension -> congestive hypersplenism -> splenic sequestration
  • Fibrinolysis increased
    • Due to decreased synthesis of alpha2 plasmin inhibitor
    • Low fibrinogen level, mild elevation of FDP and D-dimer

Treatment

  1. Lab abnormalities only (w/o significant bleeding)
    1. Observation
  2. Significant bleeding
    1. Vitamin K PO or IV
    2. Desmopressin
      1. Effective w/ minimal side effects
      2. 0.3 mg/kg IV (preferred) or SC (max 20mg)
      3. Onset of action ~1hr, duration of action ~4-24hr
    3. Cryoprecipitate
      1. May be used to replace fibrinogen in pts w/ fibrinogen levels <100
      2. 1 bag per 10kg of body weight
    4. Plts
      1. Aim for >50K for moderate risk procedures; >100K for high risk procedures
    5. FFP
      1. Use w/ caution; requires large volume of FFP to make a significant difference
    6. PPI/pepcid/octreotide (variceal bleed)

Renal Disease Induced Coagulopathy

Managment

See Also

Source

  • Tintinalli
  • UpToDate