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

Increased Clotting

Disseminated Intravascular Coagulation (DIC)

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

References

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