Abstract
Patients in the critical care unit are at high risk for both bleeding and thrombosis. Common contributors to bleeding are liver disease, thrombocytopenia, disseminated intravascular coagulation, hemodilution, and antithrombotic drugs. Routine laboratory investigations can help to understand the contributing factors in a given patient. Mainstays of therapy are coagulation factor replacement, primarily with plasma, and platelet transfusion. Contributors to the risk of thrombosis include immobility, trauma, inflammation/stress response, indwelling catheters, and both bleeding and transfusion. Management of thrombosis is challenging, requiring one to balance risks of progressive thrombosis versus hemorrhage. Unfractionated heparin still has a role in this setting, as do IVC filters in carefully selected patients.
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References
Thachil J. Disseminated intravascular coagulation: a practical approach. Anesthesiology. 2016;125(1):230–6.
Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: the past, present, and future. Hematology Am Soc Hematol Educ Program. 2017;2017(1):660–6.
Menard CE, Kumar A, Rimmer E, Doucette S. A.F. T, Houston BL, et al. evolution & impact of thrombocytopenia in septic shock. Intens Care Med Exp. 2016;4(Suppl 1):A586.
Wikkelso A, Wetterslev J, Moller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2016;8:CD007871.
Takemitsu T, Wada H, Hatada T, Ohmori Y, Ishikura K, Takeda T, et al. Prospective evaluation of three different diagnostic criteria for disseminated intravascular coagulation. Thromb Haemost. 2011;105(1):40–4.
McDaniel LM, Etchill EW, Raval JS, Neal MD. State of the art: massive transfusion. Transfus Med. 2014;24(3):138–44.
Simpson E, Lin Y, Stanworth S, Birchall J, Doree C, Hyde C. Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia. Cochrane Database Syst Rev. 2012;3:CD005011.
Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015;162(3):205–13.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552.
Cook D, Meade M, Guyatt G, Walter S, Heels-Ansdell D, Warkentin TE, et al. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med. 2011;364(14):1305–14.
Cook DJ, Crowther MA, Meade MO, Douketis J, VTEitIW P. Prevalence, incidence, and risk factors for venous thromboembolism in medical-surgical intensive care unit patients. J Crit Care. 2005;20(4):309–13.
Lim W, Meade M, Lauzier F, Zarychanski R, Mehta S, Lamontagne F, et al. Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients*. Crit Care Med. 2015;43(2):401–10.
Warkentin TE. Heparin-induced thrombocytopenia in critically ill patients. Semin Thromb Hemost. 2015;41(1):49–60.
Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006;4(4):759–65.
De Paepe P, Belpaire FM, Buylaert WA. Pharmacokinetic and pharmacodynamic considerations when treating patients with sepsis and septic shock. Clin Pharmacokinet. 2002;41(14):1135–51.
Duffett L, Carrier M. Inferior vena cava filters. J Thromb Haemost. 2017;15(1):3–12.
Marshall PS, Mathews KS, Siegel MD. Diagnosis and management of life-threatening pulmonary embolism. J Intensive Care Med. 2011;26(5):275–94.
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Houston, D.S., Zarychanski, R. (2019). Bleeding and Thrombosis in the ICU. In: LaRosa, J. (eds) Adult Critical Care Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-94424-1_16
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DOI: https://doi.org/10.1007/978-3-319-94424-1_16
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