Correction of Coagulopathy for Percutaneous Interventions

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 - platelets - coagulopathy - disseminated intravascular coagulation - reversal

REFERENCES

• 1 Davie E W, Ratnoff O D. Waterfall sequence for intrinsic blood clotting.  Science. 1964;  145 1310-1312
• 2 MacFarlane R G. An enzyme cascade in the blood clotting mechanism, and its function as a biological amplifier.  Nature. 1964;  202 498-499
• 3 Hoffman M, Monroe III D M. A cell-based model of hemostasis.  Thromb Haemost. 2001;  85(6) 958-965
• 4 Douketis J D, Berger P B, Dunn A S, Jaffer A K, Spyropoulos A C, Becker R C. Ansell. The perioperative management of antithrombotic therapy.  Chest. 2008;  133 299S-339S
• 5 White R H, McKittrick T, Hutchinson R, Twitchell J. Temporary discontinuation of warfarin therapy: changes in the international normalized ratio.  Ann Intern Med. 1995;  122(1) 40-42
• 6 Makris M, Watson H G. The management of coumarin-induced over-anticoagulation Annotation.  Br J Haematol. 2001;  114(2) 271-280
• 7 Lubetsky A, Yonath H, Olchovsky D, Loebstein R, Halkin H, Ezra D. Comparison of oral vs intravenous phytonadione (vitamin K1) in patients with excessive anticoagulation: a prospective randomized controlled study.  Arch Intern Med. 2003;  163(20) 2469-2473
• 8 Riegert-Johnson D L, Volcheck G W. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review.  Ann Allergy Asthma Immunol. 2002;  89(4) 400-406
• 9 Dezee K J, Shimeall W T, Douglas K M, Shumway N M, O'malley P G. Treatment of excessive anticoagulation with phytonadione (vitamin K): a meta-analysis.  Arch Intern Med. 2006;  166(4) 391-397
• 10 Kaul V V, Munoz S J. Coagulopathy of liver disease.  Curr Treat Options Gastroenterol. 2000;  3(6) 433-438
• 11 O'Shaughnessy D F, Atterbury C, Bolton Maggs P British Committee for Standards in Haematology, Blood Transfusion Task Force et al. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant.  Br J Haematol. 2004;  126(1) 11-28
• 12 Holland L L, Brooks J P. Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results.  Am J Clin Pathol. 2006;  126(1) 133-139
• 13 Schulman S, Bijsterveld N R. Anticoagulants and their reversal.  Transfus Med Rev. 2007;  21(1) 37-48
• 14 Leissinger C A, Blatt P M, Hoots W K, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature.  Am J Hematol. 2008;  83(2) 137-143
• 15 Holland L, Warkentin T E, Refaai M, Crowther M A, Johnston M A, Sarode R. Suboptimal effect of a three-factor prothrombin complex concentrate (Profilnine-SD) in correcting supratherapeutic international normalized ratio due to warfarin overdose.  Transfusion. 2009;  49(6) 1171-1177
• 16 Levi M, Peters M, Büller H R. Efficacy and safety of recombinant factor VIIa for treatment of severe bleeding: a systematic review.  Crit Care Med. 2005;  33(4) 883-890
• 17 Deveras R A, Kessler C M. Reversal of warfarin-induced excessive anticoagulation with recombinant human factor VIIa concentrate.  Ann Intern Med. 2002;  137(11) 884-888
• 18 Atkison P R, Jardine L, Williams S, Barr R M, Quan D, Wall W. Use of recombinant factor VIIa in pediatric patients with liver failure and severe coagulopathy.  Transplant Proc. 2005;  37(2) 1091-1093
• 19 Bosch J, Thabut D, Bendtsen F European Study Group on rFVIIa in UGI Haemorrhage et al. Recombinant factor VIIa for upper gastrointestinal bleeding in patients with cirrhosis: a randomized, double-blind trial.  Gastroenterology. 2004;  127(4) 1123-1130
• 20 Mannucci P M, Levi M. Prevention and treatment of major blood loss.  N Engl J Med. 2007;  356(22) 2301-2311
• 21 Dickneite G. Prothrombin complex concentrate versus recombinant factor VIIa for reversal of coumarin anticoagulation.  Thromb Res. 2007;  119(5) 643-651
• 22 Levy J H, Tanaka K A, Dietrich W. Perioperative hemostatic management of patients treated with vitamin K antagonists.  Anesthesiology. 2008;  109(5) 918-926
• 23 Martin J H, Rosser C J, Linebach R F, McCullough D L, Assimos D G. Are coagulation studies necessary before percutaneous nephrostomy?.  Tech Urol. 2000;  6(3) 205-207
• 24 Fisher N C, Mutimer D J. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit.  Intensive Care Med. 1999;  25(5) 481-485
• 25 Stecker M S, Johnson M S, Ying J et al.. Time to hemostasis after traction removal of tunneled cuffed central venous catheters.  J Vasc Interv Radiol. 2007;  18(10) 1232-1239 quiz 1240
• 26 Darcy M D, Kanterman R Y, Kleinhoffer M A et al.. Evaluation of coagulation tests as predictors of angiographic bleeding complications.  Radiology. 1996;  198(3) 741-744
• 27 Malloy P C, Grassi C J, Kundu S Standards of Practice Committee with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.  J Vasc Interv Radiol. 2009;  20(7, Suppl) S240-S249
• 28 Hirsh J, Bauer K A, Donati M B, Gould M, Samama M M, Weitz J I. American College of Chest Physicians . Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  Chest. 2008;  133(6, Suppl) 141S-159S
• 29 Levi M. Emergency reversal of antithrombotic treatment.  Intern Emerg Med. 2009;  4(2) 137-145
• 30 Howland M A. Antidotes in depth. In: Goldfrank LR, Nelson LS, Howland M, Lewin NA, Flomenbaum NE, Hoffman RS Goldfrank's Toxicologic Emergencies. 8^th ed. New York; McGraw-Hill 2006: 907
• 31 Hirsh J, Bauer K A, Donati M B et al.. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  Chest. 2008;  133(6 Suppl) 141S-159S
• 32 Massonnet-Castel S, Pelissier E, Bara L et al.. Partial reversal of low molecular weight heparin (PK 10169) anti-Xa activity by protamine sulfate: in vitro and in vivo study during cardiac surgery with extracorporeal circulation.  Haemostasis. 1986;  16(2) 139-146
• 33 Vavra K A, Lutz M F, Smythe M A. Recombinant factor VIIa to manage major bleeding from newer parental anticoagulants.  Ann Pharmacother. 2010 Apr;  44(4) 718-726
• 34 Bijsterveld N R, Moons A H, Boekholdt S M et al.. Ability of recombinant factor VIIa to reverse the anticoagulant effect of the pentasaccharide fondaparinux in healthy volunteers.  Circulation. 2002;  106(20) 2550-2554
• 35 Haas B, Trerotola S, Itkin M et al.. Abstract No. 89: Tunneled central venous catheter insertion in patients with coagulopathy and thrombocytopenia.  J Vasc Interv Radiol. 2009;  20(2) S35-S36
• 36 Ray Jr C E, Shenoy S S. Patients with thrombocytopenia: outcome of radiologic placement of central venous access devices.  Radiology. 1997;  204(1) 97-99
• 37 Wallace M J, Narvios A, Lichtiger B et al.. Transjugular liver biopsy in patients with hematologic malignancy and severe thrombocytopenia.  J Vasc Interv Radiol. 2003;  14(3) 323-327
• 38 The Trial to Reduce Alloimmunization to Platelets Study Group . Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions.  N Engl J Med. 1997;  337(26) 1861-1869
• 39 Heal J M, Blumberg N. Optimizing platelet transfusion therapy.  Blood Rev. 2004;  18(3) 149-165
• 40 Favaloro E J. Clinical utility of the PFA-100.  Semin Thromb Hemost. 2008;  34(8) 709-733
• 41 Weiss H J, Baumgartner H R, Tschopp T B, Turitto V T, Cohen D. Correction by factor VIII of the impaired platelet adhesion to subendothelium in von Willebrand disease.  Blood. 1978;  51(2) 267-279
• 42 Lethagen S. Desmopressin – a haemostatic drug: state-of-the-art review.  Eur J Anaesthesiol. 1997;  14 1-9
• 43 Van Dantzig J M, Duren D R, ten Cate J W. Desmopressin and myocardial infarction.  Lancet. 1989;  i 664
• 44 Bond L, Bevan D. Myocardial infarction in a patient with hemophilia treated with DDAVP.  N Engl J Med. 1988;  318(2) 121
• 45 Mannucci P M, Carlsson S, Harris A S. Desmopressin, surgery and thrombosis.  Thromb Haemost. 1994;  71(1) 154-155
• 46 Cattaneo M, Harris A S, Strömberg U, Mannucci P M. The effect of desmopressin on reducing blood loss in cardiac surgery—a meta-analysis of double-blind, placebo-controlled trials.  Thromb Haemost. 1995;  74(4) 1064-1070
• 47 Mannucci P M. Hemostatic drugs.  N Engl J Med. 1998;  339(4) 245-253
• 48 Toh C H, Dennis M. Disseminated intravascular coagulation: old disease, new hope.  BMJ. 2003;  327(7421) 974-977
• 49 Carey M J, Rodgers G M. Disseminated intravascular coagulation: clinical and laboratory aspects.  Am J Hematol. 1998;  59(1) 65-73
• 50 Bucur S Z, Hillyer C D. Cryoprecipitate and related blood procducts. In: Hillyer CD, Hillyer KL, Strobl FJ, Jeffries LC, Silberstein LE Handbook of Transfusion Medicine. San Diego; Academic Press 2001: 50-51
• 51 Drummond J C, Petrovich C T, Lane T A. Hemostasis and transfusion medicine. In: Barash PG, et al Clinical Anesthesia. Philadelphia; Lippincott Williams and Wilkins 2009: 403