Perioperatively acquired disorders of coagulation

Area of Science:

• Anesthesiology
• Hematology
• Critical Care Medicine

Background:

• Acquired coagulopathies are common in perioperative settings, trauma, and postpartum hemorrhage.
• Low fibrinogen levels and impaired fibrin polymerization contribute to bleeding complications.
• Antithrombotic medications, including novel oral anticoagulants, pose challenges in managing surgical bleeding.

Purpose of the Study:

• To review acquired coagulopathies in diverse clinical scenarios.
• To discuss coagulation disturbances related to antithrombotic agents.
• To outline strategies for reversing antithrombotic effects during hemorrhage.

Main Methods:

• Literature review of recent studies on acquired coagulopathies.
• Analysis of fibrinogen levels and fibrin polymerization in bleeding patients.
• Evaluation of reversal strategies for antithrombotic medications.

Main Results:

• Fibrinogen deficits are prevalent after cardiopulmonary bypass, in trauma patients, and postpartum.
• Reversal of novel oral anticoagulants with nonspecific agents yields conflicting results.
• Specific antidotes for novel oral anticoagulants are under development with promising initial data.

Conclusions:

• Targeted hemostatic therapy aims to correct coagulopathies and minimize allogeneic transfusions.
• Guidelines exist for reversing warfarin and antiplatelet agents.
• Evidence-based recommendations for managing drug-induced coagulopathy from novel oral anticoagulants are limited.