Difference between revisions of "Coagulopathy (main)"

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

Revision as of 13:27, 7 January 2014