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

  • Tranfuse if platelets <25,000[4][5]
  • If hemophiliac, replace factor before LP

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)
  1. Wilkerson, Annals of Emerg Med, 2009
  2. Thomsen TW. Paracentesis. N Engl J Med 2006; 355: e21
  3. 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
  4. 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
  5. 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
  6. Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
  7. Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemo- philia 2001; 7:551–556