Coagulopathy (main)

Background

• Primary hemostasis: damage to endothelial basement membrane and formation of platelet plug
• Secondary hemostasis: coagulation cascade

Coagulation cascade

Clinical Features

• Spontaneous bleeding
• Bleeding out of proportion
• Swollen joints
• Epistaxis
• Bleeding gums
• Menometrorrhagia
• Easy bruising/petechiae
• Hematuria

Differential Diagnosis

Coagulopathy

Platelet Related

• Too few
  • Thrombocytopenia
• Nonfunctional
  • Aspirin
  • Von Willebrand disease

Factor Related

• Acquired (Drug Related)
  • Warfarin (Coumadin)
  • Unfractionated heparin
  • Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
  • Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
  • Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
• Illness induced
  • Vitamin K deficiency
  • Disseminated Intravascular Coagulation (DIC)
  • Liver disease induced coagulopathy
  • Uremic bleeding syndrome
• Genetic
  • Hemophilia
  • Factor VIII inhibitor
  • Lupus anticoagulant

Increased Clotting

• Disseminated Intravascular Coagulation (DIC)
• Factor V Leiden
• Nephrotic syndrome

Management

• Bleeding Treatments
• Procedures in patients with coagulopathies
• Anticoagulant reversal (known medications)
  • Warfarin (Coumadin) Reversal
  • Dabigatran (Pradaxa) Reversal
  • Rivaroxaban reversal
  • Unfractionated heparin reversal
• Anti-platelet agent reversal

See Also

• Transfusions
• Idarucizumab