Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding

Neuenfeldt, Friederike; Weigand, Markus; Fischer, Dania

doi:10.3390/jcm10225369

Cited by 10 publications

(16 citation statements)

References 135 publications

(140 reference statements)

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“…Viscoelastic test tracing 1–4 . A10, amplitude at 10 min; CFT, clot formation time; CT, clotting time; K, kinetic time; LI30, lysis index at 30 min; LY30, lysis at 30 min; MA, maximum amplitude; MCF, maximum clot firmness; ML, maximum lysis; R/ACT, reaction time (“R time”)/activated clotting time; ROTEM, rotational thromboestometry; TEG, thromboelastography.…”

Section: Interpretation Of Vet Tracingsmentioning

confidence: 99%

“…Finally, maximum amplitude (MA; TEG) and maximum clot firmness (MCF; ROTEM) describe clot stability at its maximum strength, and therefore pertain to platelet and fibrinogen function (Table 1; Figure 1). [1][2][3][4] The third phase of coagulation is the dissolution of fibrin clot: fibrinolysis. This is measured by lysis percentage at 30 min (LY30) in TEG and lysis index at 30 min (LI30) in ROTEM (Table 1; Figure 1).…”

Section: Interpretation Of Vet Tracingsmentioning

confidence: 99%

“…This is measured by lysis percentage at 30 min (LY30) in TEG and lysis index at 30 min (LI30) in ROTEM (Table 1; Figure 1). [1][2][3][4] ROTEM also offers an additional assessment at the end of the test, maximum lysis (ML). If critical care pharmacists familiarize themselves with these concepts and parameters, they can be rapidly applied at the bedside to identify and correct coagulopathies.…”

Section: Interpretation Of Vet Tracingsmentioning

confidence: 99%

“…Coagulopathy is common in critically ill patients and may result in complications such as bleeding or thromboembolic events 1 . These events are potentially preventable or quickly treatable if identified early and approached in a targeted, patient‐specific fashion.…”

Section: Introductionmentioning

confidence: 99%

“…Coagulopathy is common in critically ill patients and may result in complications such as bleeding or thromboembolic events. 1 These events are potentially preventable or quickly treatable if identified early and approached in a targeted, patient-specific fashion. Conventional coagulation tests, including international normalized ratio (INR), thromboplastin time (aPTT), and prothrombin time (PT), were designed for drug monitoring and do not capture all coagulopathies, including procoagulant states and fibrinogen disorders.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The clot thickens: How to use viscoelastic testing in critical illness

Rech

Gilbert

Nei

et al. 2023

J Am Coll Clin Pharm

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Coagulopathy is common in critically ill patients and may result in complications such as bleeding or thromboembolic events. Viscoelastic testing (VET), including both thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), offers a benefit over conventional coagulation tests in that it provides a qualitative and quantitative assessment of the degree of coagulopathy, including the ability to measure fibrinolysis. This review is a “how‐to” primer for critical care pharmacists to interpret and utilize VET in practice across a spectrum of coagulopathies, including trauma and traumatic brain injury, neurologic injury and emergencies, cardiothoracic surgery, liver disease, and medication‐induced coagulopathy.

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Section: Interpretation Of Vet Tracingsmentioning

confidence: 99%

Section: Interpretation Of Vet Tracingsmentioning

confidence: 99%

Section: Interpretation Of Vet Tracingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The clot thickens: How to use viscoelastic testing in critical illness

Rech

Gilbert

Nei

et al. 2023

J Am Coll Clin Pharm

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Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Smith

Barlow

et al. 2023

J Am Coll Clin Pharm

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non‐trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.

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Approaches to Precision‐based Anticoagulation management in the critically Ill

Dager,

Trujillo,

Gilbert

2023

Pharmacotherapy

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Anticoagulant therapy is commonly associated with a high incidence of avoidable adverse events, especially in the acute care setting. This has led to several initiatives by key national health care stakeholders, including specific attention to The Joint Commission's National Patient Safety Goals, to improve anticoagulation management. The subject of special populations has long been identified as challenging by clinicians with the use of anticoagulants. This is driven in part by numerous variables that can contribute to hard outcomes such as bleeding, thrombosis, length of stay, hospital re‐admission, morbidity, and mortality. Despite the notable effort to improve the use of anticoagulants with numerous clinical trials, guidelines, guidance statements, and other sources of published evidence, notable difficulties continue to challenge practitioners in managing this class of medications. This is especially the case with very diverse critically ill populations where countless variables exist, many of which were never explored in trials or have historically been frequently excluded. Trials evaluating anticoagulation therapy often can only account for small portions of variables that may affect thrombosis and hemostasis, and study methods often do not reflect the constantly changing dynamic conditions seen in unique critically ill patients. Clinicians providing care to the numerous critically ill populations are faced with conditions that lead to relatively small therapeutic windows, which makes designing safe optimal anticoagulation management plans difficult when dealing with complex patients and mechanical support devices. The approach to crafting a successful management plan for anticoagulant therapy must incorporate the numerous variables that are continuously assessed and revised during the patient's time in the intensive care unit. We explore considerations and approaches when developing, assessing, and implementing an individualized or precision‐based management plan that involves the use of anticoagulants in the critically ill. The skills and thought process provided will assist clinicians in managing this unique, variable, and challenging population.

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Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding

Cited by 10 publications

References 135 publications

The clot thickens: How to use viscoelastic testing in critical illness

The clot thickens: How to use viscoelastic testing in critical illness

Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Approaches to Precision‐based Anticoagulation management in the critically Ill

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