[Management of coagulation dysfunction in critically surgical patient]

Area of Science:

• Critical care medicine
• Hematology
• Surgical pathology

Context:

• Perioperative coagulation dysfunction is a significant challenge in critically ill surgical patients.
• Secondary disseminated intravascular coagulation (DIC) is a prevalent complication, particularly in patients with decompensated hepatopathy and severe sepsis.
• Effective management requires addressing the primary disease and optimizing hemostatic status.

Purpose:

• To analyze the characteristics of perioperative coagulation dysfunction in surgical critically ill patients.
• To identify the primary type of coagulation disorder and associated conditions.
• To evaluate therapeutic strategies for managing coagulation abnormalities.

Summary:

• Retrospective analysis of 12 surgical critically ill patients revealed secondary DIC as the main perioperative coagulation disorder.
• Key management strategies include controlling the primary disease, effective source control, judicious use of hemostatic agents, and appropriate surgical techniques.
• In hepatopathy with hypofibrinogenemia, caution is advised with certain hemostatic drugs to prevent plasmin activation and fibrin depletion.
• Early administration of heparin and aprotinin, following fibrinogen supplementation, demonstrated potential benefits in mitigating hypercoagulation and hyperplasminogenemia by increasing antithrombin-III and fibrinogen levels.

Impact:

• Provides insights into the complex coagulation derangements in surgical critical care.
• Highlights the importance of tailored management strategies based on underlying conditions like hepatopathy and sepsis.
• Suggests a potential therapeutic approach involving early anticoagulation and antifibrinolytic agents in specific coagulation disorders.