Perioperative coagulopathy monitoring

Abstract

Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), ''Point-ofcare'' coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery.

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

“…Patients at high risk for thrombotic or bleeding complications should be identified by evaluating ''any possible perioperative coagulopathy'' [6]. This is a complex multifactorial condition that is difficult to diagnose and manage with the classic coagulation tests (e.g., platelet count, prothrombin time, partial thromboplastin time, d-dimer, fibrinogen, antithrombin) [7]. Indeed, classic coagulation tests are hampered by several limitations, as they explore specific stages of the clotting cascade and do not consider the various interactions between plasma factors and phospholipid surfaces with other blood components involved in the clot formation.…”

Perioperative Management Center (PERIO) for Neurosurgical Patients

“… 1) For patients undergoing a neurosurgical operation, fixed preoperative tests are needed to endure the operative stress and long operative time. Perioperative management of glucose level in blood, 2) cardiovascular function, 3) or coagulopathy monitoring 4 , 5) is important for minimizing the complications related to diabetes mellitus, cardiovascular events, or anti-coagulant therapy. Recently, self-assessment of cardiac risks before surgery plays a certain role in preoperative evaluation of patients.…”

Lumbar subcutaneous edema and degenerative spinal disease in patients with low back pain: a retrospective MRI study

“…The clinical impact of LSE in patients with low back pain seems to be underestimated: T2 FAT-SAT images should be included in the standard protocol of the lumbar spine [19,20,21,22], particularly in patients with clinical history of facet arthropathy or lumbar canal stenosis or in patients with low back pain and high BMI ([30).…”