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Hemostasis and Coagulation

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Surgery

Abstract

Bleeding is one of the major complications of surgery. Serious intraoperative and postoperative bleeding may be caused by a local problem in surgical hemostasis, such as a failed ligature, but can also be caused by a defect in the hemostatic system. Surgical hemostasis and an adequate function of the coagulation system are complementary: In some cases, a patient with a (minor) hemostatic defect may be operated upon without any specific perioperative intervention in the coagulation system, whereas in other instances improvement of blood coagulation may be necessary before operation. In this chapter, current insights into the functioning of the coagulation system, and anticoagulant and prohemostatic interventions in this system, are discussed. Subsequently, conditions associated with an enhanced risk of perioperative bleeding (including the preoperative use of anticoagulant agents) and strategies to reduce perioperative blood loss are reviewed. Last, the pathogenesis and clinical management of disseminated intravascular coagulation are discussed.

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References

  1. Colman RW, Hirsh J, Marder VJ, et al. Hemostasis and Thrombosis. Basic Principles and Clinical Practice. Philadelphia: Lippincott, 1994.

    Google Scholar 

  2. Hathaway WE, Goodnight JR SH. Disorders of Hemostasis and Thrombosis. A Clinical Guide. New York: McGraw-Hill, 1993.

    Google Scholar 

  3. Colman RW, Cook JJ, Niewiarowski. Mechanisms of platelet ag gregation. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Philadelphia: Lippincott, 1994.

    Google Scholar 

  4. Niewiarowski S, Holt JC, Cook JJ. Biochemistry and physiology of secreted platelet proteins. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Philadelphia: Lippincott, 1994.

    Google Scholar 

  5. Davie EW. Biochemical and molecular aspects of the coagulation cascade. Thromb Haemostasis 1995;74:1–7.

    CAS  Google Scholar 

  6. Davie EW, Fujikawa K, Kisiel W. The coagulation cascade: initiation, maintenance and regulation. Biochemistry 1991;30: 10363–10370.

    Article  PubMed  CAS  Google Scholar 

  7. Collen D. On the regulation and control of fibrinolysis. Thromb Haemostasis 1980;43: 77.

    CAS  Google Scholar 

  8. Hirsh J, Dalen JE, Fuster V, et al. Aspirin and other platelet-active drugs. Chest 1995; 108: 247S-2575.

    Article  PubMed  CAS  Google Scholar 

  9. Hirsh J, Dalen JE, Deykin, et al. Oral anticoagulants. Chest 1995;108: 231S–247S.

    Article  PubMed  CAS  Google Scholar 

  10. Hirsh J, Raschke R, Warkentin TE, et al. Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest 1995;108:258S–275S.

    Article  PubMed  CAS  Google Scholar 

  11. Weitz JI. Low molecular weight heparins. N Engl J Med 1997;337:688–698.

    Article  PubMed  CAS  Google Scholar 

  12. Edmunds LH, Salzman EW. Hemostatic problems, transfusion therapy, and cardiopulmonary bypass in surgical patients. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Philadelphia: Lippincott, 1994.

    Google Scholar 

  13. Mannucci PM. Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood 1997;90:2515.

    Google Scholar 

  14. Limentani SA, Roth DA, Furie BC, Furie B. Recombinant blood clotting proteins for hemophilia therapy. Semin Thromb Hemostasis 1993;19:62–72.

    Article  CAS  Google Scholar 

  15. Marder VJ, Butler FO, Barlow GH. Antifibrinolytic therapy. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Philadelphia: Lippincott, 1994.

    Google Scholar 

  16. Mannucci PM, Ruggeri ZM, Pareti FI, Capitannio A. DDAVP: A new pharmacological approach to the management of hemophilia and von Willebrand disease. Lancet 1977;I:869–872.

    Article  Google Scholar 

  17. Francis JL. The use of drugs to reduce blood loss during surgery. Hematol Rev 1992;7:85–99.

    Google Scholar 

  18. Rao AK, Ghosh S, Sum L, et al. Mechanism of platelet dysfunction and response to DDAVP in patients with congenital platelet function defects. A double-blind placebo-controlled trial. Thromb Haemostasis 1995;74:1071–1078.

    CAS  Google Scholar 

  19. McIntyre AJ. Blood transfusion and haemostatic management in the perioperative period. Can J Anaesth 1992;39:R101.

    Article  PubMed  CAS  Google Scholar 

  20. Levi M, Lensing A, ten Cate JW. Haemostasis, blood coagulation and fibrinolysis in liver disease. In: Tytgat GN, Lygidakis A, et al, eds. Hepatobiliary and Pancreatic Malignancies: Diagnosis, Medical and Surgical Therapy. Stuttgart: Thieme, 1988: 173–178.

    Google Scholar 

  21. Marassi A, Manzullo V, Di Carlo V, et al. Thromboembolism following prothrombin complex concentrate and major surgery in severe liver disease. Thromb Haemostasis 1978;39:787.

    CAS  Google Scholar 

  22. Agnelli G, Parise P, Levi M, Cosmi B, Nenci GG. Effects of desmopressin on hemostasis in patients with liver cirrhosis. Haemostasis 1995;25:241–247.

    PubMed  CAS  Google Scholar 

  23. Moia M, Mannucci PM, Vizzotto L, et al. Improvement in the hemostatic defect of uremia after treatment with recombinant human erythropoietin. Lancet 1987;2:1227.

    Article  PubMed  CAS  Google Scholar 

  24. Mannucci PM, Remuzzi G, Pusinri F, et al. De-amino-8-D-arginine vasopressin shortens the bleeding time in uremia. N Engl J Med 1983;308:8–12.

    Article  PubMed  CAS  Google Scholar 

  25. Hathaway WE. New insights on vitamin K. Hematol Oncol Clin North Am 1987;1:367.

    PubMed  CAS  Google Scholar 

  26. Kelton JG, Gibbons S. Autoimmune platelet destruction: idiopathic thrombocytopenic purpura. Semin Thromb Hemostasis 1982;8:83–104.

    Article  CAS  Google Scholar 

  27. Cohen AJ, Kessler CM. Acquired inhibitors Baillieres Clin Haematol 1996;9:331–354.

    Article  CAS  Google Scholar 

  28. Houry S, Georgeac C, Hay JM, Fingerhut A, Boudet MJ. A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Association for Surgical Research. Am J Surg 1995;170:19–23.

    Article  PubMed  CAS  Google Scholar 

  29. Watson CJ, Deane AM, Doyle PA, Bullock KN. Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin. Br J Urol 1990;66:85.

    Article  PubMed  CAS  Google Scholar 

  30. Billingsley EM, Maloney ME. Intraoperative and postoperative bleeding problems in patients taking warfarin, aspirin, and non-steroidal antiinflammatory agents. A prospective study. Dermatol Surg 1997;23:381.

    Article  PubMed  CAS  Google Scholar 

  31. Kallis P, Tooze JA, Talbot S, Cowans D, Bevan DH, Treasure T. Pre-operative aspirin decreases platelet aggregation and increases post-operative blood loss-a prospective, randomised, placebo controlled, double-blind clinical trial in 100 patients with chronic stable angina. Eur J Cardiovas Thorac Surg 1994;8:404.

    Article  CAS  Google Scholar 

  32. Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veteran Administration cooperative study. Circulation 1988;77:1324.

    Article  PubMed  CAS  Google Scholar 

  33. Flordal PA. Use of desmopressin to prevent bleeding in surgery. Eur J Surg 1998;164:5.

    Article  PubMed  CAS  Google Scholar 

  34. Bartley GB, Warndahl RA. Surgical bleeding associated with aspirin and nonsteroidal anti-inflammatory agents. Mayo Clin Proc 1992;67:402.

    Article  PubMed  CAS  Google Scholar 

  35. Horskotte D, Schulte HD, Bircks W, et al. Lower intensity anticoagulation therapy results in lower complication rates with the St. Jude medical prosthesis. J Thorac Cardiovase Surg 1994;107:1136–1145.

    Google Scholar 

  36. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med 1997;336:1506–1511.

    Article  PubMed  CAS  Google Scholar 

  37. Katholi RE, Nolan SP, McGuire LB. The management of anticoagulation during noncardiac operations in patients with prosthetic heart valves. Am Heart J 1978;96:163–165.

    Article  PubMed  CAS  Google Scholar 

  38. Nurmohamed MT, Rosendaal FR, Buller HR, et al. Low molecular weight heparin versus standard heparin in general and orthopedic surgery: a meta-analysis. Lancet 1992;340:152–156.

    Article  PubMed  CAS  Google Scholar 

  39. Fremes SE, Wong BI, Lee E, et al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg 1994;58:1580–1588.

    Article  PubMed  CAS  Google Scholar 

  40. Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood loss as the outcome. The International Study of Peri-operative Transfusion (ISPOT) Investigators. Anesth Analg 1997;85:12581267.

    Google Scholar 

  41. Levi M, Cromheecke ME, do Jonge E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 1999;354: 1940–1947.

    Article  PubMed  CAS  Google Scholar 

  42. Cattaneo M, Harris AS, Strömberg U, Mannucci PM. The effect of desmopressin on reducing blood loss in cardiac surgery. A meta-analysis of double-blind placebo-controlled trials. Thromb Haemostasis 1995;74:1064.

    CAS  Google Scholar 

  43. van der Meer J, Hillege HL, Kootstra GJ, et al, for the CABADAS Research Group of the Interuniversity Cardiology Institute of the Netherlands. Prevention of one year vein graft occlusion after aortocoronary bypass surgery: a comparison of low dose aspirin, low dose aspirin plus dypiridamole, and oral anticoagulants. Lancet 1993;342:257–264.

    Article  PubMed  Google Scholar 

  44. Garcia Huete L, Domenech P, Sabate A, et al. The prophylactic effect of aprotinin on intraoperative bleeding in liver transplantation: a randomized clinical study. Hepatology 1997;26:1143–1148.

    Article  PubMed  CAS  Google Scholar 

  45. Lentschener C, Benhamou D, Mercier FJ, et al. Aprotinin re duces blood loss in patients undergoing elective liver resection. Anesth Analg 1997;84:875–881.

    PubMed  CAS  Google Scholar 

  46. de Jonge E, Levi M, Berends F, van der Ende A, ten Cate JW, Stoutenbeek C. Impairment of haemostasis in vivo by intravenous administration of a gelatin-based plasma solution in healthy human subjects. Thromb Haemostasis 1998;79:286290.

    Google Scholar 

  47. Lim RC, Olcott C, Robinson AJ, et al. Platelet response and coagulation changes following massive blood replacement. J Trauma 1973;18:577.

    Article  Google Scholar 

  48. Reed RL, Ciavarella D, Heimbach DM, et al. Prophylactic platelet administration during massive transfusion: a prospective, randomized, double-blind clinical study. Ann Surg 1986; 203:40–48.

    Article  PubMed  Google Scholar 

  49. Roy AJ, Jaffe N, Djerassi I. Prophylactic platelet transfusions in children with acute leukemia: a dose-response study. Transfusion (Phila) 1973;13:283–290.

    Article  CAS  Google Scholar 

  50. Levi M, de Jonge E, van der Poll T, Ten Cate H. Disseminated intravascular coagulation. Thromb Haemost 1999;82:695–705.

    PubMed  CAS  Google Scholar 

  51. Baglin T. Disseminated intravascular coagulation: diagnosis and treatment. Br Med J 1996;312:683–687.

    Article  CAS  Google Scholar 

  52. Fourrier F, Chopin C, Goudemand J, et al. Septic shock, multiple organ failure, and disseminated intravascular coagulation. Compared patterns of antithrombin III, protein C, and protein S deficiencies. Chest 1992;101:816–823.

    Article  PubMed  CAS  Google Scholar 

  53. Levi M, ten Cate H, van der Poll T, et al. Pathogenesis of disseminated intravascular coagulation in sepsis. JAMA 1993;270: 975–979.

    Article  PubMed  CAS  Google Scholar 

  54. Taylor FB Jr, Chang A, Ruf W, et al. Lethal E. coli septic shock is prevented by blocking tissue factor with monoclonal antibody. Circ Shock 1991;33:127–134.

    PubMed  Google Scholar 

  55. Levi M, ten Cate H, Bauer KA, et al Inhibition of endotoxininduced activation of coagulation and fibrinolysis by pentoxifylline or by a monoclonal anti-tissue factor antibody in chimpanzees. J Clin Invest 1994;93:114–120.

    Article  PubMed  CAS  Google Scholar 

  56. van der Poll T, Buller HR, ten Cate H, et al. Activation of coagulation after administration of tumor necrosis factor to normal subjects. N Engl J Med 1990;322:1622–1627.

    Article  PubMed  Google Scholar 

  57. van der Poll T, Levi M, van Deventer SJ, et al. Differential effects of anti-tumor necrosis factor monoclonal antibodies on systemic inflammatory responses in experimental endotoxemia in chimpanzees. Blood 1994;83:446–451.

    PubMed  Google Scholar 

  58. van der Poll T, Levi M, Hack CE, et al. Elimination of interleukin 6 attenuates coagulation activation in experimental endotoxemia in chimpanzees. J Exp Med 1994;179:1253–1259.

    Article  PubMed  Google Scholar 

  59. Stouthard JM, Levi M, Hack CE, et al. Interleukin-6 stimulates coagulation, not fibrinolysis, in humans. Thromb Haemostis 1996; 76:738–742.

    CAS  Google Scholar 

  60. Boermeester MA, van Leeuwen PA, Coyle SM, et al. Interleukin- I blockade attenuates mediator release and dysregulation of the hemostatic mechanism during human sepsis. Arch Surg 1995; 130:739–748.

    Article  PubMed  CAS  Google Scholar 

  61. Buller HR, ten Cate JW. Acquired antithrombin III deficiency: laboratory diagnosis, incidence, clinical implications, and treatment with antithrombin III concentrate. Am J Med 1989; 87: 44S–48S.

    Article  PubMed  CAS  Google Scholar 

  62. Hesselvik JF, Malm J, Dahlback B, et al. Protein C, protein S and C4b-binding protein in severe infection and septic shock. Thromb Haemostis 1991;65:126–129.

    CAS  Google Scholar 

  63. Creasey AA, Chang AC, Feigen L, et al. Tissue factor pathway inhibitor reduces mortality from Escherichia coli septic shock. J Clin Invest 1993;91:2850–2856.

    Article  PubMed  CAS  Google Scholar 

  64. Biemond BJ, Levi M, ten Cate H, et al. Endotoxin-induced activation and inhibition of the fibrinolytic system: effects of various interventions in the cytokine and coagulation cascades in experimental endotoxemia in chimpanzees. Clin Sci 1995;88: 587–594.

    PubMed  CAS  Google Scholar 

  65. Levi M, van der Poll T, ten Cate H, van Deventer SJH. The cytokine-mediated imbalance between coagulant and anticoagulant mechanisms in sepsis and endotoxemia. Eur J Clin Invest 1997;27:3–9.

    Article  PubMed  CAS  Google Scholar 

  66. Corrigan JJ, Colman RW, Robboy SJ. Management of DIC. In: Inglefinger FJ, et al, eds. Controversies in Internal Medicine, Vol. II. Philadelphia: Saunders, 1974.

    Google Scholar 

  67. Wong VK, Hitchock W, Mason WH. Meningococcal infection in children: a review of 100 cases. Pediatr Infect Dis J 1989;8: 224–227.

    PubMed  CAS  Google Scholar 

  68. Gross SJ, Filston HC. Controlled study of treatment for disseminated intravascular coagulation in the neonate. J Pediatr 1982;100:445–448.

    Article  PubMed  CAS  Google Scholar 

  69. Rubin RN, Colman RW. Disseminated intravascular coagulation. Approach to treatment. Drugs 1992;44:963–971.

    Article  PubMed  CAS  Google Scholar 

  70. Corrigan JJ Jr, Kiernat JF. Effect of heparin in experimental gram-negative septicemia. J Infect Dis 1975;131:138–143.

    Article  PubMed  CAS  Google Scholar 

  71. Corrigan JJ Jr, Jordan CM. Heparin therapy in septicemia with disseminated intravascular coagulation. Effect on mortality and on correction of hemostatic defects. N Engl J Med 1970;283:778–782.

    Article  PubMed  Google Scholar 

  72. Sakuragawa N, Hasegawa H, Maki M, et al. Clinical evaluation of low-molecular-weight heparin MFR-860) on disseminated intravascular coagulation (DIC)¡ªa multicenter cooperative double-blind trial in comparison with heparin. Thromb Res 1993;72: 475–500.

    Article  PubMed  CAS  Google Scholar 

  73. Feinstein DI. Diagnosis and management of disseminated intravascular coagulation: the role of heparin therapy. Blood 1982; 60:284–287.

    PubMed  CAS  Google Scholar 

  74. Maki M, Terao T, Ikenoue T, et al. Clinical evaluation of antithrombin III concentrate CBI 6.013) for disseminated intravascular coagulation in obstetrics. Well-controlled multicenter trial. Gynecol Obstet Invest 1987;23:230–240.

    Article  PubMed  CAS  Google Scholar 

  75. Blauhut B, Kramar H, Vinazzer H, et al. Substitution of antithrombin III in shock and DIC: a randomized study. Thromb Res 1985;39:81–89.

    Article  PubMed  CAS  Google Scholar 

  76. Fourrier F, Chopin C, Huart JJ, et al. Double-blind, placebo-controlled trial of antithrombin III concentrates in septic shock with disseminated intravascular coagulation. Chest 1993;104: 882–888.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Marcel Levi
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  2. Tom van der Poll
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Editor information

Editors and Affiliations

  1. University of California, San Francisco, USA

    Jeffrey A. Norton MD (Professor and Vice-Chairman of Surgery, Chief) (Professor and Vice-Chairman of Surgery, Chief)

  2. Surgical Service, San Francisco VA Medical Center, San Francisco, California, USA

    Jeffrey A. Norton MD (Professor and Vice-Chairman of Surgery, Chief) (Professor and Vice-Chairman of Surgery, Chief)

  3. Division of General Surgery, Duke University Medical Center, Durham, North Carolina, USA

    R. Randal Bollinger MD, PhD (Professor of Surgery, Professor of Immunology, Chief) (Professor of Surgery, Professor of Immunology, Chief)

  4. Division of Surgical Oncology, University of Michigan, Comprehensive Cancer Center, Ann Arbor, Michigan, USA

    Alfred E. Chang MD (Chief, Hugh Cabot Professor of Surgery) (Chief, Hugh Cabot Professor of Surgery)

  5. Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

    Stephen F. Lowry MD (Professor and Chairman) (Professor and Chairman)

  6. Division of General Surgery, University of California, San Francisco, San Francisco, California, USA

    Sean J. Mulvihill MD (Professor of Surgery, Chief) (Professor of Surgery, Chief)

  7. Karmanos Cancer Institute, Wayne State University, Harper Hospital, Detroit, Michigan, USA

    Harvey I. Pass MD (Professor of Surgery and Oncology, Chief of Thoracic Oncology) (Professor of Surgery and Oncology, Chief of Thoracic Oncology)

  8. Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri, USA

    Robert W. Thompson MD (Associate Professor of Surgery) (Associate Professor of Surgery)

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Levi, M., van der Poll, T. (2001). Hemostasis and Coagulation. In: Norton, J.A., et al. Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-57282-1_9

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  • DOI: https://doi.org/10.1007/978-3-642-57282-1_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63239-6

  • Online ISBN: 978-3-642-57282-1

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