Skip to main content
SpringerLink
Log in

Coagulation Abnormalities in the Critically Ill

  • Chapter
Surgical Intensive Care Medicine

Abstract

Bleeding is one of the major complications of surgery. Serious intraoperative and postoperative bleeding may be caused not only by a local problem in surgical hemostasis, such as a failed ligature, but can also be caused by a defect in the hemostatic system. Surgical hemostasis and an adequate function of the coagulation system are complementary; in some cases, a patient with a (minor) hemostatic defect may be operated upon without any specific perioperative intervention in the coagulation system, whereas in other instances improvement of blood coagulation may be necessary before surgery.1

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Levi M, van der Poll T. Hemostasis and coagulation. In: Norton JA, Bollinger RA, Chang AE, Lowry SF, editors. Surgery: scientific basis and current practice. 2001.

    Google Scholar 

  2. Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Crit Care. 2006;10:222–231.

    Article  PubMed  Google Scholar 

  3. Chakraverty R, Davidson S, Peggs K, Stross P, Garrard C, Littlewood TJ. The incidence and cause of coagulopathies in an intensive care population. Br J Haematol. 1996;93:460–463.

    Article  PubMed  CAS  Google Scholar 

  4. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44.

    Article  PubMed  Google Scholar 

  5. Stephan F, Hollande J, Richard O, et al. Thrombocytopenia in a surgical ICU. Chest. 1999;115:1363–1370.

    Article  PubMed  CAS  Google Scholar 

  6. Hanes SD, Quarles DA, Boucher BA. Incidence and risk factors of thrombocytopenia in critically ill trauma patients. Ann Pharmacother. 1997;31:285–289.

    PubMed  CAS  Google Scholar 

  7. Akca S, Haji Michael P, de Medonca A, Suter PM, Levi M, Vincent JL. The time course of platelet counts in critically ill patients. Crit Care Med. 2002;30:753–756.

    Article  PubMed  Google Scholar 

  8. Vanderschueren S, De Weerdt A, Malbrain M, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;28:1871–1876.

    Article  PubMed  CAS  Google Scholar 

  9. Baughman RP, Lower EE, Flessa HC, Tollerud DJ. Thrombocytopenia in the intensive care unit. Chest. 1993;104:1243–1247.

    Article  PubMed  CAS  Google Scholar 

  10. Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med. 2002;30:1765–1771.

    Article  PubMed  Google Scholar 

  11. Oppenheim-Eden A, Glantz L, Eidelman LA, Sprung CL. Spontaneous intracerebral hemorrhage in critically ill patients: incidence over six years and associated factors. Intensive Care Med. 1999;25:63–67.

    Article  PubMed  CAS  Google Scholar 

  12. Shorr AF, Thomas SJ, Alkins SA, Fitzpatrick TM, Ling GS. d-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients. Chest. 2002;121:1262–1268.

    Article  PubMed  Google Scholar 

  13. Owings JT, Gosselin RC, Anderson JT, Battistella FD, Bagley M, Larkin EC. Practical utility of the d-dimer assay for excluding thromboembolism in severely injured trauma patients. J Trauma. 2001;51:425–429.

    Article  PubMed  CAS  Google Scholar 

  14. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344:699–709.

    Article  PubMed  CAS  Google Scholar 

  15. Gando S, Nanzaki S, Sasaki S, Kemmotsu O. Significant correlations between tissue factor and thrombin markers in trauma and septic patients with disseminated intravascular coagulation. Thromb Haemost. 1998;79:1111–1115.

    PubMed  CAS  Google Scholar 

  16. Greaves M, Preston FE. Approach to the bleeding patient. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN, editors. Hemostasis and thrombosis. Basic principles and clinical practice. Philadelphia: Lippingcott William&Wilkins; 2001. p. 1031–1043.

    Google Scholar 

  17. Edmunds LH. Hemostatic problems in surgical patients. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN, editors. Hemostasis and Thrombosis. Basic principles and clinical practice. Philadelphia: Lippingcott William&Wilkins; 2001. p. 1031–1043.

    Google Scholar 

  18. Kitchen S, Preston FE. Standardization of prothrombin time for laboratory control of oral anticoagulant therapy. Semin Thromb Hemost. 1999;25:17–25.

    Article  PubMed  CAS  Google Scholar 

  19. Bailey B, Amre DK, Gaudreault P. Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med. 2003;31:299–305.

    Article  PubMed  CAS  Google Scholar 

  20. Mavrommatis AC, Theodoridis T, Orfanidou A, Roussos C, Christopoulou-Kokkinou V, Zakynthinos S. Coagulation system and platelets are fully activated in uncomplicated sepsis. Crit Care Med. 2000;28:451–457.

    Article  PubMed  CAS  Google Scholar 

  21. Folman CC, Linthorst GE, van Mourik J, et al. Platelets release thrombopoietin (Tpo) upon activation: another regulatory loop in thrombocytopoiesis? Thromb Haemost. 2000;83:923–930.

    PubMed  CAS  Google Scholar 

  22. Francois B, Trimoreau F, Vignon P, Fixe P, Praloran V, Gastinne H. Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor. Am J Med. 1997;103:114–120.

    Article  PubMed  CAS  Google Scholar 

  23. Warkentin TE, Aird WC, Rand JH. Platelet-endothelial interactions: sepsis, HIT, and antiphospholipid syndrome. Hematology (Am Soc Hematol Educ Program). 2003;497–519.

    Google Scholar 

  24. Levi M, ten Cate H. Disseminated intravascular coagulation [Review] [52 refs]. N Engl J Med. 1999;341:586–592.

    Article  PubMed  CAS  Google Scholar 

  25. Verma AK, Levine M, Shalansky SJ, Carter CJ, Kelton JG. Frequency of heparin-induced thrombocytopenia in critical care patients. Pharmacotherapy. 2003;23:745–753.

    Article  PubMed  Google Scholar 

  26. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995;332:1330–1335.

    Article  PubMed  CAS  Google Scholar 

  27. Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol. 2003;121:535–555.

    Article  PubMed  CAS  Google Scholar 

  28. Sheridan D, Carter C, Kelton JG. A diagnostic test for heparin-induced thrombocytopenia. Blood. 1986;67:27–30.

    PubMed  CAS  Google Scholar 

  29. Moake JL. Thrombotic microangiopathies. N Engl J Med. 2002;347:589–600.

    Article  PubMed  CAS  Google Scholar 

  30. Tsai HM. Platelet activation and the formation of the platelet plug: deficiency of ADAMTS13 causes thrombotic thrombocytopenic purpura. Arterioscler Thromb Vasc Biol. 2003;23:388–396.

    Article  PubMed  Google Scholar 

  31. Makoni SN. Acute profound thrombocytopenia following angioplasty: the dilemma in the management and a review of the literature. Heart. 2001;86:18e.

    Article  Google Scholar 

  32. Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med. 1999;340:207–214.

    Article  PubMed  CAS  Google Scholar 

  33. Levi M, de Jonge E, Meijers J. The diagnosis of disseminated intravascular coagulation. Blood Rev. 2002;16:217–223.

    Article  PubMed  Google Scholar 

  34. Levi M. Current understanding of disseminated intravascular coagulation. Br J Haematol. 2004;124:567–576.

    Article  PubMed  Google Scholar 

  35. Taylor FBJ, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327–1330.

    PubMed  CAS  Google Scholar 

  36. Dhainaut JF, Yan SB, Joyce DE, et al. Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost. 2004;2:1924–1933.

    Article  PubMed  CAS  Google Scholar 

  37. Stefanidis I, Hagel J, Frank D, Maurin N. Hemostatic alterations during continuous venovenous hemofiltration in acute renal failure. Clin Nephrol. 1996;46:199–205.

    PubMed  CAS  Google Scholar 

  38. Muntean W. Coagulation and anticoagulation in extracorporeal membrane oxygenation. Artif Organs. 1999;23:979–983.

    Article  PubMed  CAS  Google Scholar 

  39. Rodgers RP, Levin J. A critical reappraisal of the bleeding time [Review] [231 refs]. Semin Thromb Hemost. 1990;16:1–20.

    Article  PubMed  CAS  Google Scholar 

  40. Forestier F, Coiffic A, Mouton C, Ekouevi D, Chene G, Janvier G. Platelet function point-of-care tests in post-bypass cardiac surgery: are they relevant? Br J Anaesth. 2002;89:715–721.

    Article  PubMed  CAS  Google Scholar 

  41. Levi M. Cancer and DIC. Haemostasis. 2001;31(Suppl 1):47–48.

    PubMed  Google Scholar 

  42. Teufelsbauer H, Proidl S, Havel M, Vukovich T. Early activation of hemostasis during cardiopulmonary bypass: evidence for thrombin mediated hyperfibrinolysis. Thromb Haemost. 1992;68:250–252.

    PubMed  CAS  Google Scholar 

  43. Hirsh J, Heddle N, Kelton JG. Treatment of heparin-induced thrombocytopenia: a critical review. Arch Intern Med. 2004;164:361–369.

    Article  PubMed  CAS  Google Scholar 

  44. Hellstern P, Muntean W, Schramm W, Seifried E, Solheim B. Practical guidelines for the clinical use of plasma. Thromb Res. 2002;107(Suppl 1):S53.

    Article  PubMed  CAS  Google Scholar 

  45. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356:2301–2311.

    Article  PubMed  CAS  Google Scholar 

  46. Mannucci PM. Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years [Review] [66 refs]. Blood. 1997;90:2515–2521.

    PubMed  CAS  Google Scholar 

  47. Levi M, Cromheecke ME, de Jonge E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints [see comments]. Lancet. 1999;354:1940–1947.

    Article  PubMed  CAS  Google Scholar 

  48. Porte RJ, Molenaar IQ, Begliomini B, et al. Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study. EMSALT Study Group. Lancet. 2000;355(9212):1303–1309.

    Article  PubMed  CAS  Google Scholar 

  49. Friederich PW, Henny CP, Messelink EJ, et al. Effect of recombinant activated factor VII on perioperative blood loss in patients undergoing retropubic prostatectomy: a double-blind placebo-controlled randomised trial. Lancet. 2003;361:201–205.

    Article  PubMed  CAS  Google Scholar 

  50. Hedner U, Erhardtsen E. Potential role for rFVIIa in transfusion medicine. Transfusion. 2002;42:114–124.

    Article  PubMed  CAS  Google Scholar 

  51. Roberts HR. Recombinant factor VIIa (Novoseven) and the safety of treatment. Semin Hematol. 2001;38:48–50.

    Article  PubMed  CAS  Google Scholar 

  52. Levi M, Levy M, Williams MD, et al. Prophylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated). Am J Respir Crit Care Med. 2007;176(5):483–490.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands

    Marcel Levi MD, PhD (Professor of Medicine, Chairman)

  2. Division of Infectious Diseases, The Memorial Hospital of Rhode Island, Brown University, Pawtucket, RI, USA

    Steven M. Opal MD, PhD (Professor)

Authors
  1. Marcel Levi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven M. Opal MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgical Critical Care Division of Surgery, The Lahey Clinic Medical Center, Burlington, MA, USA

    John M. O’Donnell (Director, Surgical Intensive Care Unit Chairman) (Director, Surgical Intensive Care Unit Chairman)

  2. University Hospital Intensive Care Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Flávio E. Nácul

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Levi, M., Opal, S.M. (2010). Coagulation Abnormalities in the Critically Ill. In: O’Donnell, J.M., Nácul, F.E. (eds) Surgical Intensive Care Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-77893-8_33

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-77893-8_33

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-77892-1

  • Online ISBN: 978-0-387-77893-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation