[Coagulation and the general surgeon. Its physiology and laboratory tests]

Area of Science:

• Hematology
• Surgical Physiology

Context:

• Coagulation is a complex physiological process involving platelets, plasma enzymes, and various organ systems.
• Vessel endothelium plays a dual role in regulating platelet adhesion, coagulation, and fibrinolysis.
• Understanding these mechanisms is crucial for managing surgical bleeding and thrombosis.

Purpose:

• To outline the physiological mechanisms of blood coagulation and fibrinolysis.
• To discuss physiopathological conditions affecting coagulation, including platelet activation, endothelial lesions, and hypercoagulability.
• To recommend appropriate laboratory tests for assessing coagulation status in surgical patients.

Summary:

• The study details the intricate interplay of platelet and plasma coagulation systems, emphasizing the role of activators, inhibitors, and organ systems like the liver and lungs.
• It highlights that whole blood coagulates faster than plasma and discusses pathological conditions such as consumption coagulopathy and disseminated intravascular coagulation.
• Recommendations are made for preoperative coagulation assessment, prioritizing whole blood tests like thromboelastography over plasma-specific assays.

Impact:

• Provides a framework for selecting cost-effective and informative laboratory tests for surgical coagulation assessment.
• Aims to improve patient safety by ensuring adequate preoperative evaluation of hemostasis.
• Applicable to general and digestive surgery, guiding clinicians in routine pre-procedural evaluations.