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Coagulation testing in the perioperative period.

Thiruvenkatarajan V, Pruett A, Adhikary SD - Indian J Anaesth (2014)

Bottom Line: Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients.While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests.A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia ; Discipline of Acute Care Medicine, The University of Adelaide, South Australia.

ABSTRACT
Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients. Anaesthesia providers play a critical role in the decision-making on transfusion and/or haemostatic therapy in the surgical setting. Various tests are available in identifying coagulation abnormalities in the perioperative period. While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests. The introduction of newer anticoagulant medications and the implementation of the modified in vivo coagulation cascade have given a new dimension to the field of perioperative transfusion medicine. A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

No MeSH data available.


Related in: MedlinePlus

Cell-based model of coagulation. The Roman numerals represent coagulation factors (Reproduced from Andy NG Curry, JM Tom Pierce, Conventional and near-patient tests of coagulation, Contin Educ Anaesth Crit Care Pain, (2007) 7(2):45-50, by permission of Oxford University Press)
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Figure 1: Cell-based model of coagulation. The Roman numerals represent coagulation factors (Reproduced from Andy NG Curry, JM Tom Pierce, Conventional and near-patient tests of coagulation, Contin Educ Anaesth Crit Care Pain, (2007) 7(2):45-50, by permission of Oxford University Press)

Mentions: Haemostasis is a combination of a number of events that occur in a sequence following the breach of vascular integrity. They include vasoconstriction, platelet aggregation, thrombus formation, recanalization and healing. Conventionally, secondary haemostasis was described as intrinsic and extrinsic pathways merging at a final common pathway.[1] This in vitro model ignores the link between primary and secondary haemostasis and is not applicable in vivo. The currently employed cell-based model of coagulation reflects the in vivo process and it differs from the previous model in two key ways [Figure 1]. First, the complex formed by the tissue factor and factor VII contributes in the activation of factor IX, demonstrating that the intrinsic and extrinsic coagulation pathways are interconnected almost from the beginning of the process. Second, the complete process requires three consecutive phases: An initial phase, an amplification phase, and the propagation phase. Platelets and thrombin are actively involved in the last two phases.


Coagulation testing in the perioperative period.

Thiruvenkatarajan V, Pruett A, Adhikary SD - Indian J Anaesth (2014)

Cell-based model of coagulation. The Roman numerals represent coagulation factors (Reproduced from Andy NG Curry, JM Tom Pierce, Conventional and near-patient tests of coagulation, Contin Educ Anaesth Crit Care Pain, (2007) 7(2):45-50, by permission of Oxford University Press)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260302&req=5

Figure 1: Cell-based model of coagulation. The Roman numerals represent coagulation factors (Reproduced from Andy NG Curry, JM Tom Pierce, Conventional and near-patient tests of coagulation, Contin Educ Anaesth Crit Care Pain, (2007) 7(2):45-50, by permission of Oxford University Press)
Mentions: Haemostasis is a combination of a number of events that occur in a sequence following the breach of vascular integrity. They include vasoconstriction, platelet aggregation, thrombus formation, recanalization and healing. Conventionally, secondary haemostasis was described as intrinsic and extrinsic pathways merging at a final common pathway.[1] This in vitro model ignores the link between primary and secondary haemostasis and is not applicable in vivo. The currently employed cell-based model of coagulation reflects the in vivo process and it differs from the previous model in two key ways [Figure 1]. First, the complex formed by the tissue factor and factor VII contributes in the activation of factor IX, demonstrating that the intrinsic and extrinsic coagulation pathways are interconnected almost from the beginning of the process. Second, the complete process requires three consecutive phases: An initial phase, an amplification phase, and the propagation phase. Platelets and thrombin are actively involved in the last two phases.

Bottom Line: Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients.While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests.A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia ; Discipline of Acute Care Medicine, The University of Adelaide, South Australia.

ABSTRACT
Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients. Anaesthesia providers play a critical role in the decision-making on transfusion and/or haemostatic therapy in the surgical setting. Various tests are available in identifying coagulation abnormalities in the perioperative period. While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests. The introduction of newer anticoagulant medications and the implementation of the modified in vivo coagulation cascade have given a new dimension to the field of perioperative transfusion medicine. A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

No MeSH data available.


Related in: MedlinePlus