Assessment and management of coagulopathy in neurocritical care

Salem, Ahmed M.; Roh, David; Kitagawa, Ryan S.; Choi, H. Alex; Chang, Tiffany R.

doi:10.18700/jnc.190086

Cited by 14 publications

(4 citation statements)

References 79 publications

(100 reference statements)

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“…However, it does not necessarily correlate with blood tests such as international normalized ratio (INR), APTT, and platelet count. 8 With the knowledge of the principles of the tests used for the initial coagulation screen, and the awareness of the rare coagulation disorders, a systematic approach can be applied in the management of such patients.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Coagulopathy in Patients with Normal Preoperative Coagulation Screen: A Couple of Coagulopathic Clinical Case Conundrums

Monteiro

Goraksha

Dhokte

et al. 2020

J Neuroanaesth Crit Care

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Perioperative coagulopathy impacts patient outcome by influencing intraoperative hemodynamics and blood loss. We present two cases which despite having normal preoperative coagulation profiles and normotension during the surgery had intraoperative coagulopathy and unusual bleeding. These cases required a multidisciplinary approach to manage them successfully. A thorough knowledge of the coagulation cascade along with a high-degree of suspicion and early recognition of coagulation is required. Abnormalities are critical for a timely intervention. Point-of-care tests like thromboelastography (TEG) as well as platelet function studies helped us arrive at an early diagnosis and initiate prompt treatment.

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Section: Discussionmentioning

confidence: 99%

Perioperative Coagulopathy in Patients with Normal Preoperative Coagulation Screen: A Couple of Coagulopathic Clinical Case Conundrums

Monteiro

Goraksha

Dhokte

et al. 2020

J Neuroanaesth Crit Care

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“…8 9 Even though TEG parameters are correlated with CCS in detecting hypo- or hypercoagulability, 10 11 TEG seems to be superior in predicting bleeding and the need for transfusions. 12 13 Currently, TEG is used in many acute clinical settings such as cardiopulmonary bypass, massive trauma, and liver transplant surgeries. 14 There is increasing interest in the use of TEG in the field of stroke due to its power in quantifying coagulability, fibrinolysis, and detecting the effects or harms of anticoagulant and antiplatelet therapy.…”

mentioning

confidence: 99%

The Applicability of Thromboelastography in Acute Ischemic Stroke: A Literature Review

Pirlog

Grotta

2022

Semin Thromb Hemost

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Acute ischemic stroke (AIS) due to cerebral artery occlusion is often treated by thrombolytics or antithrombotic drugs. Thromboelastography (TEG) is a noninvasive test that provides a dynamic overview of the coagulation process. TEG may help guide thrombolytic and antithrombotic therapy in AIS. This article aims to highlight the potential use of TEG in AIS patients by reviewing available studies. We conducted a literature review, including PubMed and Cochrane library databases. The following keywords were used to find relevant studies: thromboelastography, TEG, acute ischemic stroke, stroke, coagulopathy, antiplatelet, and anticoagulant treatment. We identified 142 papers and after abstract review, we included 24 studies in this report. TEG identified a hypercoagulable state in AIS patients represented by short R, K, and greater α angle in all papers included. Modification of TEG parameters induced by intravenous thrombolysis was inconsistent but prolonged lysis (increased LY30) and weaker clots (lower maximum amplitude) were most frequent. TEG detected hypo-coagulopathy induced by dual antiplatelet therapy as well as antiplatelet drug resistance, with ticagrelor and aspirin having greater inhibition of platelet activity. A prolonged R-value seems to be the most reliable TEG parameter in detecting the anticoagulant effect of factor Xa inhibitor treatment. TEG might represent a useful point-of-care test for emergency decision-making in AIS patients and a tool for individualized treatment options. This hypothesis needs validation in a large cohort of prospectively studied AIS patients.

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“…Measurement of pin synchronisation with the cup reflects the stages of clot formation.Source: Salem et al 2019. [ 13 ] Reproduced with permission from The Korean Neurocritical Care Society under a Creative Commons (CC BY-NC) licence.…”

mentioning

confidence: 99%

“…[ 12 ] Its use in neurocritical care has allowed neurointensivists to elucidate different coagulopathy profiles among patients with intracerebral haemorrhage, subarachnoid haemorrhage and traumatic brain injury. [ 13 ] More recently, it has been used with increasing frequency in the medical intensive care unit as a means of assessing the coagulopathy of coronavirus disease 2019 (COVID-19). [ 14 , 15 ]…”

mentioning

confidence: 99%

Viscoelastic Haemostatic Assays in Cardiovascular Critical Care

et al. 2021

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The initiation and management of anticoagulation is a fundamental practice for a wide variety of indications in cardiovascular critical care, including the management of patients with acute MI, stroke prevention in patients with AF or mechanical valves, as well as the prevention of device thrombosis and thromboembolic events with the use of mechanical circulatory support and ventricular assist devices. The frequent use of antiplatelet and anticoagulation therapy, in addition to the presence of concomitant conditions that may lead to a propensity to bleed, such as renal and liver dysfunction, present unique challenges. The use of viscoelastic haemostatic assays provides an additional tool allowing clinicians to strike a delicate balance of attaining adequate anticoagulation while minimising the risk of bleeding complications. In this review, the authors discuss the role that viscoelastic haemostatic assay plays in cardiac populations (including cardiac surgery, heart transplantation, extracorporeal membrane oxygenation, acute coronary syndrome and left ventricular assist devices), and identify areas in need of further study.

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Assessment and management of coagulopathy in neurocritical care

Cited by 14 publications

References 79 publications

Perioperative Coagulopathy in Patients with Normal Preoperative Coagulation Screen: A Couple of Coagulopathic Clinical Case Conundrums

Perioperative Coagulopathy in Patients with Normal Preoperative Coagulation Screen: A Couple of Coagulopathic Clinical Case Conundrums

The Applicability of Thromboelastography in Acute Ischemic Stroke: A Literature Review

Viscoelastic Haemostatic Assays in Cardiovascular Critical Care

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