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. 2010 Dec;27(4):338-47.
doi: 10.1055/s-0030-1267857.

Correction of coagulopathy for percutaneous interventions

Charles Wiltrout, Kimi L Kondo

Correction of coagulopathy for percutaneous interventions

Charles Wiltrout et al. Semin Intervent Radiol. 2010 Dec.

Abstract

Due to medical illness or pharmacotherapy, patients undergoing percutaneous interventions often have abnormal hemostasis. Its etiology may include alterations in the protein-based coagulation system, thrombocytopenia, deficient platelet function, or mixed deficits such as disseminated intravascular coagulation. In this article, the authors review the basic science of each of these etiologies, as well as their available methods of correction. They also review the evidence and guidelines regarding the assessment and treatment of coagulopathy in image-guided procedures. The periprocedural bleeding risk and the urgency of a given procedure guide the management of abnormal hemostasis in this patient population.

Keywords: Anticoagulation; coagulopathy; disseminated intravascular coagulation; platelets; reversal.

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Figures

Figure 1
Figure 1
The classic “cascade” model of coagulation. PK, prekallikrein; HMWK, high molecular weight kininogen; TF, tissue factor.
Figure 2
Figure 2
The cell-based model of coagulation. Dashed boxes represent complexes on the tissue-factor (TF) bearing cell during initiation. Solid boxes represent factors or factor complexes on the platelet surface during amplification and propagation.
Figure 3
Figure 3
Reversal of vitamin-K antagonist (VKA) anticoagulation in the periprocedural setting. Recommendations are based on American College of Chest Physician guidelines. *rFVIIa is not approved by the Food and Drug Administration (FDA) for VKA reversal and dosing is widely variable. †Prothrombin complex concentrates (PCCs) available in the United States are not effective for VKA reversal and are not FDA-approved for this indication. Dosing is widely variable. INR, international normalized ratio.
See this image and copyright information in PMC

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