Thrombotest Levels in Relation to Recurrences and Bleeding Complications in Long-Term Treatment of Patients Suffering from Coronary Heart Disease

Dijk, Cornelia A.; Dominicus, Wilhelmina B.; Roos, J. P.

doi:10.1007/978-94-010-3423-4_44

Cited by 1 publication

(1 citation statement)

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“…7,22 Spontaneous bleeding occurs only in severe disturbances of hemostasis, as shown in studies of patients receiving oral anticoagulants (which lead to similar levels of vitamin K-dependent clotting factors as in severe hepatic insufficiency). 23 In most cases, local bleeding sources such as esophageal varices, gastric or duodenal ulcers, or invasive medical procedures are the underlying cause. 24 The coagulation disorder nevertheless contributes predominantly to the severity of the bleeding event.…”

Section: Hepatic Coagulopathy Pathophysiologymentioning

confidence: 99%

Management of Acquired Coagulation Disorders in Emergency and Intensive-Care Medicine

Staudinger

Locker²,

Frass³

1996

Semin Thromb Hemost

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Coagulation disorders usually confront the emergency physician as bleeding episodes or as abnormalities of laboratory tests. Bleeding has to be treated aggressively, while pathological coagulation tests should be related to a more differentiated diagnosis at first. The most common causes of acquired coagulation disorders are liver disease, vitamin K deficiency, and disseminated intravascular coagulation (DIC). More rarely, inhibitors, external factors such as drugs or extracorporeal circulation, or other diseases such as amyloidosis are present. Since localized hemorrhage is the most common bleeding source in liver disease, endoscopic and surgical therapeutic measures, respectively, are warranted. Careful and balanced substitution therapy according to laboratory findings should be initiated simultaneously and should consist of fresh frozen plasma (FFP), which contains all components of the coagulation system physiologically balanced. Prothrombin complex concentrates should be used in emergency situations only, keeping their potential hazards in mind. Adequate vitamin K substitution is indicated in liver disease as well as in coagulopathy due to vitamin K deficiency. Management of DIC primarily consists of aggressive treatment of the underlying disease. Substitution therapy is difficult and should be carefully monitored by the adequate laboratory tests. FFP is the adequate source of both procoagulants and inhibitors but may cause certain problems. Heparin therapy can be beneficial but is not recommended generally. Antithrombin III substitution cannot be assumed as established therapy so far. Inhibitors can lead to bleeding, but the most common inhibitor, lupus anticoagulant, rather predisposes to thrombosis. In bleeding patients with inhibitors against single clotting factors, treatment consists of adequate substitution before initiating the diagnostic workup.

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