Abstract
Operative therapy in thrombocytopenic or coagulopathic patients, especially those with an underlying malignant condition, remains a challenge in surgical practice today. This chapter provides an overview over causes and treatment options for thrombocytopenia and coagulopathies in cancer patients. Mechanism of action, half-life, and reversibility are discussed for several pharmaceutical anticoagulants including warfarin, heparin, low-molecular-weight heparin, fondaparinux, direct factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), and direct factor IIa inhibitors (dabigatran, argatroban, and bivalirudin). Availability and costs of absorbable matrix products, biologic agents, and energy-based devices as options for intraoperative hemostatic support are being reviewed. Knowledge of physiologic mechanisms and pharmaceutical hemostatic options will complement thoughtful indications and diligent intraoperative techniques applied by the surgeon taking care of cancer patients with increased bleeding risks.
Keywords
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von Holzen, U.W., Agarwal, S., Schwarz, R.E. (2017). Surgery in the Thrombocytopenic and Coagulopathic Patient. In: Fong, Y., Kauffmann, R., Marcinkowski, E., Singh, G., Schoellhammer, H. (eds) Surgical Emergencies in the Cancer Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-44025-5_4
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