Coagulopathies and Anticoagulation

  • Jeremy W. CannonEmail author


Acute hemorrhage, acute thrombosis, and management of anticoagulation are common challenges in critical care medicine. An array of acquired conditions result in coagulopathy. These include liver disease, acute trauma, cardiopulmonary bypass, and anticoagulation with both standard and novel agents. Furthermore, congenital or acquired conditions such as von Willebrand disease and hemophilia can complicate otherwise straightforward surgery or can result in life-threatening bleeding from relatively minor trauma. Patients also frequently require the initiation or discontinuation of anticoagulation while in the ICU. The following chapter describes the most common coagulopathies seen in the ICU and outlines a practical management approach to reversing coagulopathy and managing anticoagulation in the critical care setting.


Coagulopathy Hemorrhage Hemostasis Thrombosis Anticoagulation 


  1. 1.
    Hunt BJ. Bleeding and coagulopathies in critical care. N Engl J Med. 2014;370(9):847–59.CrossRefGoogle Scholar
  2. 2.
    Roberts HR, Hoffman M, Monroe DM. A cell-based model of thrombin generation. Semin Thromb Hemost. 2006;32 Suppl 1:32–8.CrossRefGoogle Scholar
  3. 3.
    Mann KG. Thrombin generation in hemorrhage control and vascular occlusion. Circulation. 2011;124(2):225–35.CrossRefPubMedGoogle Scholar
  4. 4.
    Hoffman M, Cichon LJH. Practical coagulation for the blood banker. Transfusion (Paris). 2013;53(7):1594–602.CrossRefGoogle Scholar
  5. 5.
    Koreth R, Weinert C, Weisdorf DJ, Key NS. Measurement of bleeding severity: a critical review. Transfusion (Paris). 2004;44(4):605–17.CrossRefGoogle Scholar
  6. 6.
    Schulman S. World federation of hemophilia: drugs that can cause bleeding [internet]. Cited 4 Jul 2015.
  7. 7.
    Masclee GMC, Valkhoff VE, Coloma PM, de Ridder M, Romio S, Schuemie MJ, et al. Risk of upper gastrointestinal bleeding from different drug combinations. Gastroenterology. 2014;147(4):784–92.e9, quiz e13–4.CrossRefGoogle Scholar
  8. 8.
    Auerbach AD, Vittinghoff E, Maselli J, Pekow PS, Young JQ, Lindenauer PK. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med. 2013;173(12):1075–81.CrossRefGoogle Scholar
  9. 9.
    Clinical use of coagulation tests,UpToDate 2015, Zehnder JL. (Accessed on July 1, 2015.)Google Scholar
  10. 10.
    Suchman AL, Griner PF. Diagnostic uses of the activated partial thromboplastin time and prothrombin time. Ann Intern Med. 1986;104(6):810–6.CrossRefGoogle Scholar
  11. 11.
    Kamal AH, Tefferi A, Pruthi RK. How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults. Mayo Clin Proc. 2007;82(7):864–73.CrossRefGoogle Scholar
  12. 12.
    Vandiver JW, Vondracek TG. Antifactor Xa levels versus activated partial thromboplastin time for monitoring unfractionated heparin. Pharmacotherapy. 2012;32(6):546–58.CrossRefGoogle Scholar
  13. 13.
    Finley A, Greenberg C. Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass. Anesth Analg. 2013;116(6):1210–22.CrossRefGoogle Scholar
  14. 14.
    Schöchl H, Voelckel W, Grassetto A, Schlimp CJ. Practical application of point-of-care coagulation testing to guide treatment decisions in trauma. J Trauma Acute Care Surg. 2013;74(6):1587–98.CrossRefGoogle Scholar
  15. 15.
    Mallett SV, Armstrong M. Point-of-care monitoring of haemostasis. Anaesthesia. 2015;70 Suppl 1:73–7. e25–6.CrossRefGoogle Scholar
  16. 16.
    Goodman MD, Makley AT, Hanseman DJ, Pritts TA, Robinson BRH. All the bang without the bucks: defining essential point-of-care testing for traumatic coagulopathy. J Trauma Acute Care Surg. 2015;79(1):117–24.CrossRefPubMedGoogle Scholar
  17. 17.
    Heneghan C, Ward A, Perera R, Self-Monitoring Trialist Collaboration, Bankhead C, Fuller A, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet Lond Engl. 2012;379(9813):322–34.CrossRefGoogle Scholar
  18. 18.
    Matchar DB, Jacobson A, Dolor R, Edson R, Uyeda L, Phibbs CS, et al. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363(17):1608–20.CrossRefGoogle Scholar
  19. 19.
    Caldwell SH, Hoffman M, Lisman T, Macik BG, Northup PG, Reddy KR, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatol Baltim MD. 2006;44(4):1039–46.CrossRefGoogle Scholar
  20. 20.
    Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–56.CrossRefGoogle Scholar
  21. 21.
    Schouten JN, Francque S, Van Vlierberghe H, Colle I, Nevens F, Delwaide J, et al. The influence of laboratory-induced MELD score differences on liver allocation: more reality than myth. Clin Transpl. 2012;26(1):E62–70.CrossRefGoogle Scholar
  22. 22.
    Lee JH, Kweon OJ, Lee M-K, Lee HW, Kim HJ, Kim HR. Clinical usefulness of international normalized ratio calibration of prothrombin time in patients with chronic liver disease. Int J Hematol. 2015;102:163–9.CrossRefGoogle Scholar
  23. 23.
    Mallett SV. Clinical Utility of Viscoelastic Tests of Coagulation (TEG/ROTEM) in patients with liver disease and during liver transplantation. Semin Thromb Hemost. 2015;41(5):527–37.CrossRefGoogle Scholar
  24. 24.
    Lewis EA, Pigott MA, Randall A, Hepper AE. The development and introduction of ballistic protection of the external genitalia and perineum. J R Army Med Corps. 2013;159(Suppl):i15–7.CrossRefGoogle Scholar
  25. 25.
    Villa E, Cammà C, Marietta M, Luongo M, Critelli R, Colopi S, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology. 2012;143(5):1253–60.e1–4.CrossRefGoogle Scholar
  26. 26.
    Werner KT, Sando S, Carey EJ, Vargas HE, Byrne TJ, Douglas DD, et al. Portal vein thrombosis in patients with end stage liver disease awaiting liver transplantation: outcome of anticoagulation. Dig Dis Sci. 2013;58(6):1776–80.CrossRefGoogle Scholar
  27. 27.
    Coagulation abnormalities in patients with liver disease. UpToDate 2015, Shah NL, Northup PG, Caldwell SH. (Accessed on July 1, 2015.)Google Scholar
  28. 28.
    Maegele M, Schöchl H, Cohen MJ. An update on the coagulopathy of trauma. Shock. 2014;41:21–5.CrossRefGoogle Scholar
  29. 29.
    Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care Lond Engl. 2013;17(2):R76.CrossRefGoogle Scholar
  30. 30.
    Duchesne JC, McSwain NE, Cotton BA, Hunt JP, Dellavolpe J, Lafaro K, et al. Damage control resuscitation: the new face of damage control. J Trauma Inj Infect Crit Care. 2010;69(4):976–90.CrossRefGoogle Scholar
  31. 31.
    Nunez TC, Young PP, Holcomb JB, Cotton BA. Creation, implementation, and maturation of a massive transfusion protocol for the exsanguinating trauma patient. J Trauma. 2010;68(6):1498–505.CrossRefPubMedGoogle Scholar
  32. 32.
    Gonzalez E, Moore EE, Moore HB, Chapman MP, Chin TL, et al. Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays. Ann Surg. 2016;263(6):1051–1059.CrossRefPubMedGoogle Scholar
  33. 33.
    Park MS, Martini WZ, Dubick MA, Salinas J, Butenas S, Kheirabadi BS, et al. Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time. J Trauma. 2009;67(2):266–75. discussion 275–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Hunt H, Stanworth S, Curry N, Woolley T, Cooper C, Ukoumunne O, et al. Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding. Cochrane Database Syst Rev. 2015;2:CD010438.Google Scholar
  35. 35.
    Callcut RA, Cotton BA, Muskat P, Fox EE, Wade CE, Holcomb JB, et al. Defining when to initiate massive transfusion: a validation study of individual massive transfusion triggers in PROMMTT patients. J Trauma Acute Care Surg. 2013;74(1):59–65. 67–8; discussion 66–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82.CrossRefPubMedGoogle Scholar
  37. 37.
    del Junco DJ, Holcomb JB, Fox EE, Brasel KJ, Phelan H a, Bulger EM, et al. Resuscitate early with plasma and platelets or balance blood products gradually: findings from the PROMMTT study. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S24–30.CrossRefPubMedGoogle Scholar
  38. 38.
    Behalf of CRASH O, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Indian J Neurotrauma. 2012;9(1):3–14.CrossRefGoogle Scholar
  39. 39.
    Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113–9.CrossRefGoogle Scholar
  40. 40.
    Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB, et al. Results of the CONTROL trial: efficacy and safety of recombinant activated factor VII in the management of refractory traumatic hemorrhage. J Trauma Inj Infect Crit Care. 2010;69(3):489–500.CrossRefGoogle Scholar
  41. 41.
    Boffard KD, Riou B, Warren B, Choong PIT, Rizoli S, Rossaint R, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled. Double-Blind Clin Trials: J Trauma Inj Infect Crit Care. 2005;59(1):8–18.Google Scholar
  42. 42.
    Goldstein JN, Refaai MA, Milling TJ, Lewis B, Goldberg-Alberts R, Hug BA, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet Lond Engl. 2015;385(9982):2077–87.CrossRefGoogle Scholar
  43. 43.
    Gordon JL, Fabian TC, Lee MD, Dugdale M. Anticoagulant and antiplatelet medications encountered in emergency surgery patients: a review of reversal strategies. J Trauma Acute Care Surg. 2013;75(3):475–86.CrossRefGoogle Scholar
  44. 44.
    Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci. 2010;47(5–6):197–212.CrossRefGoogle Scholar
  45. 45.
    Kilic A, Whitman GJR. Blood transfusions in cardiac surgery: indications, risks, and conservation strategies. Ann Thorac Surg. 2014;97(2):726–34.CrossRefGoogle Scholar
  46. 46.
    Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos A-M, Vandvik PO, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e691S–736.CrossRefPubMedGoogle Scholar
  47. 47.
    Giannakopoulos B, Krilis SA. The pathogenesis of the antiphospholipid syndrome. N Engl J Med. 2013;368(11):1033–44.CrossRefPubMedGoogle Scholar
  48. 48.
    Reddy P. Laboratory diagnosis of antiphospholipid syndrome. South Med J. 2013;106(7):439–46.CrossRefGoogle Scholar
  49. 49.
    Hirsh J, Warkentin TE, Shaughnessy SG, Anand SS, Halperin JL, Raschke R, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001;119(1 Suppl):64S–94.CrossRefGoogle Scholar
  50. 50.
    Levine MN, Hirsh J, Gent M, Turpie AG, Cruickshank M, Weitz J, et al. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Arch Intern Med. 1994;154(1):49–56.CrossRefGoogle Scholar
  51. 51.
    Management of warfarin-associated bleeding or supratherapeutic INR. UpToDate 2015, Hull RD, Garcia DA. (Accessed on July 1, 2015.)Google Scholar
  52. 52.
    Frontera JA, Lewin Iii JJ, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, et al. Guideline for reversal of antithrombotics in intracranial hemorrhage : a statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care. 2016;24(1):6–46.CrossRefGoogle Scholar
  53. 53.
    Baumann Kreuziger LM, Morton CT, Dries DJ. New anticoagulants: a concise review. J Trauma Acute Care Surg. 2012;73(4):983–92.CrossRefGoogle Scholar
  54. 54.
    Pollack CV, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373(6):511–20.CrossRefPubMedGoogle Scholar
  55. 55.
    Sadler JE, Mannucci PM, Berntorp E, Bochkov N, Boulyjenkov V, Ginsburg D, et al. Impact, diagnosis and treatment of von Willebrand disease. Thromb Haemost. 2000;84(2):160–74.CrossRefGoogle Scholar
  56. 56.
    Lison S, Dietrich W, Spannagl M. Review article: unexpected bleeding in the operating room: the role of acquired von Willebrand disease. Anesth Analg. 2012;114(1):73–81.CrossRefGoogle Scholar
  57. 57.
    Bartoli CR, Restle DJ, Zhang DM, Acker MA, Atluri P. Pathologic von Willebrand factor degradation with a left ventricular assist device occurs via two distinct mechanisms: mechanical demolition and enzymatic cleavage. J Thorac Cardiovasc Surg. 2015;149(1):281–9.CrossRefGoogle Scholar
  58. 58.
    Mensah PK, Gooding R. Surgery in patients with inherited bleeding disorders. Anaesthesia. 2015;70:112–e40.CrossRefGoogle Scholar
  59. 59.
    Oldenburg J. Optimal treatment strategies for hemophilia: achievements and limitations of current prophylactic regimens. Blood. 2015;125(13):2038–44.CrossRefGoogle Scholar
  60. 60.
    Cohen AJ, Kessler CM. Treatment of inherited coagulation disorders. Am J Med. 1995;99(6):675–82.CrossRefGoogle Scholar
  61. 61.
    Escobar M, Maahs J, Hellman E, Donkin J, Forsyth A, Hroma N, et al. Multidisciplinary management of patients with haemophilia with inhibitors undergoing surgery in the United States: perspectives and best practices derived from experienced treatment centres. Haemophilia. 2012;18(6):971–81.CrossRefGoogle Scholar
  62. 62.
    Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127.CrossRefPubMedGoogle Scholar
  63. 63.
    Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248(3):447–58.PubMedGoogle Scholar
  64. 64.
    Radwan ZA, Bai Y, Matijevic N, del Junco DJ, McCarthy JJ, Wade CE, et al. An emergency department thawed plasma protocol for severely injured patients. JAMA Surg. 2013;148(2):170–5.CrossRefPubMedGoogle Scholar
  65. 65.
    Watson GA, Sperry JL, Rosengart MR, Minei JP, Harbrecht BG, Moore EE, et al. Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome. J Trauma. 2009;67(2):221–30.CrossRefGoogle Scholar
  66. 66.
    Park PK, Cannon JW, Ye W, Blackbourne LH, Holcomb JB, Beninati W, et al. Transfusion strategies and development of acute respiratory distress syndrome in combat casualty care. J Trauma Acute Care Surg. 2013;75(2 Suppl 2):S238–46.CrossRefGoogle Scholar
  67. 67.
    Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion on coagulation test results. Am J Clin Pathol. 2006;126(1):133–9.CrossRefGoogle Scholar
  68. 68.
    West KL, Adamson C, Hoffman M. Prophylactic correction of the international normalized ratio in neurosurgery: a brief review of a brief literature. J Neurosurg. 2011;114(1):9–18.CrossRefGoogle Scholar
  69. 69.
    Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e227S–77.CrossRefPubMedGoogle Scholar
  70. 70.
    Joseph B, Pandit V, Harrison C, Lubin D, Kulvatunyou N, Zangbar B, et al. Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe? Am J Surg. 2015;209(1):194–8.CrossRefGoogle Scholar
  71. 71.
    Santaniello JM, Miller PR, Croce MA, Bruce L, Bee TK, Malhotra AK, et al. Blunt aortic injury with concomitant intra-abdominal solid organ injury: treatment priorities revisited. J Trauma. 2002;53(3):442–5. discussion 445.CrossRefGoogle Scholar
  72. 72.
    Pastorek RA, Cripps MW, Bernstein IH, Scott WW, Madden CJ, Rickert KL, et al. The Parkland Protocol’s modified Berne-Norwood criteria predict two tiers of risk for traumatic brain injury progression. J Neurotrauma. 2014;31(20):1737–43.CrossRefPubMedGoogle Scholar
  73. 73.
    Kwiatt ME, Patel MS, Ross SE, Lachant MT, MacNew HG, Ochsner MG, et al. Is low-molecular-weight heparin safe for venous thromboembolism prophylaxis in patients with traumatic brain injury? A Western Trauma Association multicenter study. J Trauma Acute Care Surg. 2012;73(3):625–8.CrossRefGoogle Scholar
  74. 74.
    Nathens AB, McMurray MK, Cuschieri J, Durr EA, Moore EE, Bankey PE, et al. The practice of venous thromboembolism prophylaxis in the major trauma patient. J Trauma. 2007;62(3):557–62. discussion 562–3.CrossRefGoogle Scholar
  75. 75.
    Phelan HA, Wolf SE, Norwood SH, Aldy K, Brakenridge SC, Eastman AL, et al. A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk traumatic brain injury: the Delayed Versus Early Enoxaparin Prophylaxis I (DEEP I) study. J Trauma Acute Care Surg. 2012;73(6):1434–41.CrossRefGoogle Scholar
  76. 76.
    Lip GYH, Lane DA. Stroke prevention in atrial fibrillation: a systematic review. JAMA. 2015;313(19):1950–62.CrossRefGoogle Scholar
  77. 77.
    Atrial fibrillation: anticuagulant therapy to prevent embolization. UpToDate 2015, Manning WJ, Singer DE, Lip GYH. (Accessed on July 1, 2015.)Google Scholar
  78. 78.
    Friberg L, Rosenqvist M, Lip GYH. Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study. Circulation. 2012;125(19):2298–307.CrossRefGoogle Scholar
  79. 79.
    Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet Lond Engl. 2014;383(9921):955–62.CrossRefGoogle Scholar
  80. 80.
    Salazar CA, del Aguila D, Cordova EG. Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation. Cochrane Database Syst Rev. 2014;3:CD009893.Google Scholar
  81. 81.
    Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–100.CrossRefPubMedGoogle Scholar
  82. 82.
    Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, Endres M, Sobesky J, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA. 2015;313(8):824–36.CrossRefPubMedGoogle Scholar
  83. 83.
    Atrial fibrillation and flutter after cardiac surgery. UpToDate 2015, Knight BP. (Accessed on July 1, 2015.)Google Scholar
  84. 84.
    Makhija Z, Allen MS, Wigle DA, Shen KR, Cassivi SD, Nichols FC, et al. Routine anticoagulation is not indicated for postoperative general thoracic surgical patients with new-onset atrial fibrillation. Ann Thorac Surg. 2011;92(2):421–6. discussion 426–7.CrossRefGoogle Scholar
  85. 85.
    Baron RM. Point: should coagulopathy be repaired prior to central venous line insertion? Yes: why take chances? Chest. 2012;141(5):1139–42.CrossRefGoogle Scholar
  86. 86.
    Goldhaber SZ. Counterpoint: should coagulopathy be repaired prior to central venous line insertion? Chest. 2012;141(5):1142–4.CrossRefGoogle Scholar
  87. 87.
    Kornblith LZ, Burlew CC, Moore EE, Haenel JB, Kashuk JL, Biffl WL, et al. One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am Coll Surg. 2011;212(2):163–70.CrossRefGoogle Scholar
  88. 88.
    Barton CA, McMillian WD, Osler T, Charash WE, Igneri PA, Brenny NC, et al. Anticoagulation management around percutaneous bedside procedures: is adjustment required? J Trauma Acute Care Surg. 2012;72(4):815–20. quiz 1124–5.CrossRefGoogle Scholar
  89. 89.
    Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e326S–50.CrossRefPubMedGoogle Scholar
  90. 90.
    Dunn AS, Turpie AGG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med. 2003;163(8):901–8.CrossRefGoogle Scholar
  91. 91.
    Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998 Feb 12;338(7):409–15.Google Scholar
  92. 92.
    Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S829–61.CrossRefGoogle Scholar
  93. 93.
    Logan JK, Pantle H, Huiras P, Bessman E, Bright L. Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism. Am J Emerg Med. 2014;32(7):789–96.CrossRefGoogle Scholar
  94. 94.
    Phelan HA. Pharmacologic venous thromboembolism prophylaxis after traumatic brain injury: a critical literature review. J Neurotrauma. 2012;29(10):1821–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (, which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Division of Traumatology, Surgical Critical Care & Emergency SurgeryPenn Presbyterian Medical CenterPhiladelphiaUSA

Personalised recommendations