Treatment of Coagulopathy

Bleeding is an inherent risk in virtually all vascular and interventional radiology (VIR) procedures. Appropriately, all VIR preprocedural assessments should take into consideration a patient's coagulopathic state as a potential contraindication. Coagulopathic abnormalities are particularly common in critically ill patients, many of whom may require emergent, life-saving VIR interventions. As the landscape of VIR transitions toward an emphasis of VIR physicians serving as clinicians rather than proceduralists/technicians, it is becoming more important that VIR physicians understand and provide appropriate clinical recommendations regarding management of common coagulopathies. This section will first cover common anticoagulants and antithrombotic agents, as well as their reversal agents. This will be followed by evaluation and medical management of common critical care coagulopathies such as disseminated intravascular coagulation, heparin-induced thrombocytopenia, uremic platelet dysfunction, and coagulopathy secondary to liver disease. Finally, this discussion will cover the role of blood product transfusions in correcting coagulopathies. Management of various coagulopathies in context of low vs high bleeding risk VIR procedures, as defined by the Society of Interventional Radiology guidelines, will also be discussed. Understanding these common coagulopathies will allow the VIR physician to provide guidance to primary teams in correcting coagulopathic abnormalities so that a VIR intervention may proceed in a timely manner for these critically ill patients.