Procedures in patients with coagulopathies - Revision history

Mholtz at 05:50, 7 July 2017

2017-07-07T05:50:49Z

← Revisión anterior		Revisión del 05:50 7 jul 2017
Línea 2:		Línea 2:
	*Evidence is mostly retrospective studies or case reports		*Evidence is mostly retrospective studies or case reports
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
	~~===Cirrhosis<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>===~~
	*INR is a poor marker of coagulation in [[cirrhosis]]
	*Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics
	*Each 100 cc infusion of plasma increases portal venous pressure by 1 mmHg (normal pressure 5-10 mmHg)
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
	**Do not use PT/INR to risk stratify liver disease patients
	**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL

	==[[Central line\|Central Line]]==		==[[Central line\|Central Line]]==
Línea 23:		Línea 14:
	==[[Thoracentesis]]==		==[[Thoracentesis]]==
	{{Thoracentesis with coagulopathy}}		{{Thoracentesis with coagulopathy}}

			==Specific Populations==
			===Cirrhosis<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>===
			*INR is a poor marker of coagulation in [[cirrhosis]]
			*Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics
			*Each 100 cc infusion of plasma increases portal venous pressure by 1 mmHg (normal pressure 5-10 mmHg)
			*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion
			**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
			**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
			**Do not use PT/INR to risk stratify liver disease patients
			**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL

	==See Also==		==See Also==
	*[[Coagulopathy (Main)]]		*[[Coagulopathy (Main)]]

	==~~Further Reading~~==		==External Links==
	*~~Indravadan P. et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. J Vasc Interv Radiol 2012 '''[~~http://www.sirweb.org/clinical/cpg/4E8CAd01.pdf ~~PDF]'''~~		*http://www.sirweb.org/clinical/cpg/4E8CAd01.pdf

	==References==		==References==

Kxl328 at 02:30, 20 August 2016

2016-08-20T02:30:05Z

← Revisión anterior		Revisión del 02:30 20 ago 2016
Línea 5:		Línea 5:
	*INR is a poor marker of coagulation in [[cirrhosis]]		*INR is a poor marker of coagulation in [[cirrhosis]]
	*Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics		*Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion~~, which increases portal hypertension~~		*Each 100 cc infusion of plasma increases portal venous pressure by 1 mmHg (normal pressure 5-10 mmHg)
			*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)		**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>		**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>

Kxl328 at 02:28, 20 August 2016

2016-08-20T02:28:20Z

← Revisión anterior		Revisión del 02:28 20 ago 2016
Línea 2:		Línea 2:
	*Evidence is mostly retrospective studies or case reports		*Evidence is mostly retrospective studies or case reports
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
	===Cirrhosis===		===Cirrhosis<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>===
	*INR is a poor marker of coagulation in [[cirrhosis]]		*INR is a poor marker of coagulation in [[cirrhosis]]
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension~~<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>~~		*Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics
	**Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics		*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)		**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>		**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>

Kxl328 at 02:27, 20 August 2016

2016-08-20T02:27:31Z

← Revisión anterior		Revisión del 02:27 20 ago 2016
Línea 2:		Línea 2:
	*Evidence is mostly retrospective studies or case reports		*Evidence is mostly retrospective studies or case reports
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
			===Cirrhosis===
			*INR is a poor marker of coagulation in [[cirrhosis]]
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>		*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>
	**Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics		**Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics

Kxl328 at 02:26, 20 August 2016

2016-08-20T02:26:37Z

← Revisión anterior		Revisión del 02:26 20 ago 2016
Línea 3:		Línea 3:
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>		*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>
			**Risk of post-procedure bleeding for minimally invasive procedures ~20% in cirrhotics
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)		**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>		**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>

Kxl328 at 02:24, 20 August 2016

2016-08-20T02:24:55Z

← Revisión anterior		Revisión del 02:24 20 ago 2016
Línea 4:		Línea 4:
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>		*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)		**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to ~~protein C and S~~ deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>		**Thus, cirrhotic patients may be hypercoagulable despite high INR due to natural anticoagulant deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
	**Do not use PT/INR to risk stratify liver disease patients		**Do not use PT/INR to risk stratify liver disease patients
	**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL		**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL

Kxl328 at 02:23, 20 August 2016

2016-08-20T02:23:53Z

← Revisión anterior		Revisión del 02:23 20 ago 2016
Línea 2:		Línea 2:
	*Evidence is mostly retrospective studies or case reports		*Evidence is mostly retrospective studies or case reports
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>		*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)		**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to protein C and S deficiencies<ref>		**Thus, cirrhotic patients may be hypercoagulable despite high INR due to protein C and S deficiencies<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
	**Do not use PT/INR to risk stratify liver disease patients		**Do not use PT/INR to risk stratify liver disease patients
	**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL		**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL

Kxl328 at 02:23, 20 August 2016

2016-08-20T02:23:13Z

← Revisión anterior		Revisión del 02:23 20 ago 2016
Línea 2:		Línea 2:
	*Evidence is mostly retrospective studies or case reports		*Evidence is mostly retrospective studies or case reports
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
	*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>		*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.<ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
	**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)		**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
	**Thus, cirrhotic patients may be hypercoagulable despite high INR due to protein C and S deficiencies<ref>		**Thus, cirrhotic patients may be hypercoagulable despite high INR due to protein C and S deficiencies<ref>

Kxl328 at 02:22, 20 August 2016

2016-08-20T02:22:41Z

← Revisión anterior		Revisión del 02:22 20 ago 2016
Línea 2:		Línea 2:
	*Evidence is mostly retrospective studies or case reports		*Evidence is mostly retrospective studies or case reports
	*Clinical practice should account for totality of circumstances, including operator experience		*Clinical practice should account for totality of circumstances, including operator experience
			*Correction of elevated INR in [[cirrhosis]] leads to unnecessary volume expansion, which increases portal hypertension<ref>Caldwell SH. Management of Coagulopathy in Liver Disease. Gastroenterol Hepatol (N Y). 2014 May; 10(5): 330–332.</ref>Brea Lipe and Deborah L. Ornstein. Deficiencies of Natural Anticoagulants, Protein C, Protein S, and Antithrombin. Published: October 4, 2011. Circulation. http://circ.ahajournals.org/content/124/14/e365.</ref>
			**PT/INR only measures the procoagulant pathway and does not detect anticoagulant pathway (protein C and S, antithrombin)
			**Thus, cirrhotic patients may be hypercoagulable despite high INR due to protein C and S deficiencies<ref>
			**Do not use PT/INR to risk stratify liver disease patients
			**Rather use target platelet count with goal > 50,000 uL and fibrinogen level > 120 mg/dL

	==[[Central line\|Central Line]]==		==[[Central line\|Central Line]]==

Mholtz at 10:38, 3 April 2016

2016-04-03T10:38:37Z

← Revisión anterior		Revisión del 10:38 3 abr 2016
Línea 1:		Línea 1:
	==Background==		==Background==
	*~~All of the below rules are guidelines with~~ mostly retrospective ~~and~~ case ~~report evidence. All rules need to~~ account for operator experience~~. The most experienced operator should perform the procedure.~~		*Evidence is mostly retrospective studies or case reports
			*Clinical practice should account for totality of circumstances, including operator experience

	==[[Central line\|Central Line]]==		==[[Central line\|Central Line]]==