Difference between revisions of "Coagulopathy (main)"

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==Vitamin K Deficiency==
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==Background==
#FFP
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*Primary hemostasis: damage to endothelial basement membrane and formation of platelet plug
#Vitamin K (+/- takes 24hrs to affect & 2wk to wear off)
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*Secondary hemostasis: coagulation cascade
 +
[[File:Coagulation cascade.png|thumbnail|Coagulation cascade]]
  
==Warfarin==
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==Clinical Features==
*See [[Warfarin (Coumadin) Reversal]]
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*Spontaneous [[hemorrhage|bleeding]]
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*Bleeding out of proportion
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*Swollen joints
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*[[Epistaxis]]
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*Bleeding gums
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*[[vaginal Bleed Non-Pregnant|Menometrorrhagia]]
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*Easy bruising/[[petechiae]]
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*[[Hematuria]]
  
==Heparin/Lovenox==
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==Differential Diagnosis==
*See [[Heparin (Unfractionated)]]
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{{Increased bleeding DDX}}
  
==DIC==
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===Increased Clotting===
*See [[DIC]]
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*[[Disseminated Intravascular Coagulation (DIC)]]
  
==Hemophilia==
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==Management==
*See [[Hemophilia]]
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*[[Bleeding Treatments]]
 
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*[[Procedures in patients with coagulopathies]]
==Factor VIII Inhibitor==
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*[[Anticoagulant reversal]] (known medications)
#(PTT does not correct after mixing)
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**[[Warfarin (Coumadin) Reversal]]
#high dose Factor VII, prothrombin, or recombinant factor VIIa
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**[[Dabigatran (Pradaxa) Reversal]]
 
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**[[Rivaroxaban reversal]]
==Lupus Anticoagulant==
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**[[Unfractionated heparin reversal]]
#(rare)
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*[[Anti-platelet agent reversal]]
#warfarin or ASA
 
 
 
==Liver Disease==
 
===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==
 
===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
 
  
 
==See Also==
 
==See Also==
*[[Bleeding Treatments]]
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*[[Transfusions]]
 
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*[[Idarucizumab]]
==Source==
 
*Tintinalli
 
*UpToDate
 
  
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==References==
 +
<references/>
 
[[Category:Heme/Onc]]
 
[[Category:Heme/Onc]]

Latest revision as of 00:16, 1 October 2019

Background

  • Primary hemostasis: damage to endothelial basement membrane and formation of platelet plug
  • Secondary hemostasis: coagulation cascade
Coagulation cascade

Clinical Features

Differential Diagnosis

Coagulopathy

Platelet Related

Factor Related

Increased Clotting

Management

See Also

References