Procedures in patients with coagulopathies
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Paracentesis
- Coagulation studies are NOT required before performance of the procedure[1]
- No data supports cutoff values beyond which paracent should be avoided/prophylactically transfused
- Routine use of FFP and platelets is not recommended
- Contraindicated if the patient is actively bleeding or in DIC and the incidence of clinically significant bleeding complications is low even if in liver failure with an elevated INR (< 0.2%)[2]
Thoracentesis
- Consider transfusion of platelets if platelets <50,000, or Fresh Frozen Plasma if PT/PTT twice the normal range [3]
Lumbar Puncture
Central Line
- No benefit FFP unless you lacerate an artery[6]
- However, consider if patient is a hemophilia[7]
- Favor using a compressible site such as the femoral location if coagulopathic and avoid the IJ and Subclavian
See Also
Sources
- Indravadan P. et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions PDF
- Roberts, Clin Proc Emer Med 2004; Yu (Clin Liv Dz '01)
- ↑ Wilkerson, Annals of Emerg Med, 2009
- ↑ Thomsen TW. Paracentesis. N Engl J Med 2006; 355: e21
- ↑ 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
- ↑ 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
- ↑ 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. Haemo- philia 2001; 7:551–556