Síguenos en Twitter     Síguenos en Facebook     Síguenos en Google+     Síguenos en YouTube     Siguenos en Linkedin     Correo Grupsagessa     Gmail     Yahoo Mail     Dropbox     Instagram     Pinterest     Slack     Google Drive     Reddit     StumbleUpon     Print

SOBRE EL AUTOR **

Mi foto
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

Rapid IJ (aka Easy Internal Jugular Cannulation)

Buscar en contenido

Contenido:

lunes, 7 de diciembre de 2015

Coagulopatía en el cirrótico sangrante

PulmCrit - December 7, 2015 by Josh Farkas
"Introduction
Hemorrhage is a common cause of death in cirrhosis, especially variceal bleeding. These patients often have complex coagulopathies. Furthermore, some coagulation abnormalities may precede variceal re-bleeding (Chau 1998). Thus, immediate and definitive coagulation management is important. Unfortunately, the traditional approach is misguided and potentially dangerous...
  • Most cirrhotics are in a state of rebalanced hemostasis, due to similar reductions in pro- and anti-coagulant proteins. This often yields a normal overall clotting tendency.
  • INR measures the level of clotting factors only, not the overall balance of coagulation. To determine the balance of enzymatic coagulation, thromboelastography (TEG) is needed.
  • Responding to an elevated INR by transfusing FFP is a misguided practice which should be abandoned. Cirrhotics rarely have true enzymatic hypocoagulability, so they generally do not benefit from FFP.
  • For patients with cirrhosis and bleeding, repletion of fibrinogen and platelets may be more effective in achieving hemostasis.
  • A subset of patients with advanced cirrhosis appear to have hyperfibrinolysis. Such patients may benefit from tranexamic acid.
  • In the context of a variceal hemorrhage, over-resuscitation may aggravate bleeding by markedly increasing the blood pressure within the varicies.
  • Our general strategy of repleting blood factors individually to target a roughly “euboxic” coagulation panel should be questioned. It is possible that focusing on the overall balance of coagulation and fibrinolysis, rather than individually normalizing each component, may allow for a more flexible and effective approach.
  • For now, the following approach may be reasonable:
http://emcrit.org/pulmcrit/coagulopathy-bleeding-cirrhotic-inr/