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Perioperative coagulation management in the intensive care unit

Jerrold H Levy1, David Faraoni, Roman M Sniecinski

  • 1Emory University School of Medicine and Emory Healthcare, Atlanta, Georgia 30322, USA. Jlevy01@emory.edu

Current Opinion in Anaesthesiology
|November 13, 2012
PubMed

Insights

Newer anticoagulants can cause coagulopathy in critically ill patients. Management involves blood products, prohemostatic drugs, and specific coagulation therapies to address deficiencies.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Pharmacology

Background:

  • Coagulopathy in intensive care unit (ICU) patients is complex, stemming from surgery, trauma, and medications.
  • Newer anticoagulation agents, including new oral anticoagulants (NOACs) and antiplatelet agents, are increasingly recognized as contributors.
  • Understanding these multifactorial causes is crucial for effective patient management.

Purpose of the Study:

  • To review the causes of coagulopathy in ICU patients.
  • To discuss hemostatic considerations and therapeutic strategies.
  • To highlight the role of newer anticoagulants in ICU coagulopathy.

Main Methods:

  • Review of current literature on ICU coagulopathy.
  • Analysis of contributing factors, including anticoagulation therapies.
  • Evaluation of available management options.

Main Results:

  • All anticoagulation agents can potentially induce coagulopathy in critically ill patients.
  • Management strategies include hemodialysis, blood product transfusion, and prohemostatic drugs.
  • Recombinant and purified coagulation therapies offer targeted treatment for specific deficiencies.

Conclusions:

  • ICU coagulopathy results from multiple factors: anticoagulants, dilution, fibrinolysis, and factor consumption.
  • Therapeutic prohemostatic pharmacologic approaches are essential alongside standard transfusion therapy.
  • A comprehensive understanding and tailored approach are vital for managing ICU coagulopathy.
Abstract

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