Download PDF
Semin intervent Radiol 2022; 39(04): 428-434
DOI: 10.1055/s-0042-1758150
Review Article

Correcting Coagulopathy for Image-Guided Procedures

Paula M. Novelli
1   Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Joshua M. Tublin
2   UPMC Medical Education Program, Pittsburgh, Pennsylvania
,
Philip D. Orons
1   Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
› Author Affiliations Funding No funding source was applied to this paper.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Patients with acquired coagulopathy often require percutaneous image-guided invasive procedures for urgent control of hemorrhage or for elective procedures. Routine preprocedural evaluation of coagulopathy previously focused on absolute prothrombin time, partial thromboplastin time, international normalized ratio, and platelet count values. Now viscoelastic testing and greater understanding of patient- and drug-specific changes in coagulation profiles can yield better coagulation profile data. More specific reversal agents and profiles combine for less generalized and more titrated transfusion or correction algorithms. This article reviews procedural and patient-specific factors for defining both hemorrhagic risk and correction strategies.

Keywords

interventional radiology - coagulopathy - hemorrhage - hemostasis - clotting disorders


Publication History

Article published online:
17 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions - Part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
    CrossrefPubMedGoogle Scholar
  • 2 Davidson JC, Rahim S, Hanks SE. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions - Part I: review of anticoagulation agents and clinical considerations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1155-1167
    CrossrefPubMedGoogle Scholar
  • 3 Tagariello G, Radossi P, Salviato R. et al. Clinical relevance of isolated prolongation of the activated partial thromboplastin time in a cohort of adults undergoing surgical procedures. Blood Transfus 2017; 15 (06) 557-561
    PubMedGoogle Scholar
  • 4 Storey RF. Biology and pharmacology of the platelet P2Y12 receptor. Curr Pharm Des 2006; 12 (10) 1255-1259
    CrossrefPubMedGoogle Scholar
  • 5 Holinstat M. Normal platelet function. Cancer Metastasis Rev 2017; 36 (02) 195-198
    CrossrefPubMedGoogle Scholar
  • 6 Broos K, Feys HB, De Meyer SF, Vanhoorelbeke K, Deckmyn H. Platelets at work in primary hemostasis. Blood Rev 2011; 25 (04) 155-167
    CrossrefPubMedGoogle Scholar
  • 7 Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology (Am Soc Hematol Educ Program) 2010; 2010: 135-143
    CrossrefPubMedGoogle Scholar
  • 8 Reis SP, DeSimone N, Barnes L. et al. The utility of viscoelastic testing in patients undergoing IR procedures. J Vasc Interv Radiol 2017; 28 (01) 78-87
    CrossrefPubMedGoogle Scholar
  • 9 Warner MA, Woodrum D, Hanson A, Schroeder DR, Wilson G, Kor DJ. Preprocedural platelet transfusion for patients with thrombocytopenia undergoing interventional radiology procedures is not associated with reduced bleeding complications. Transfusion 2017; 57 (04) 890-898
    CrossrefPubMedGoogle Scholar
  • 10 Thompson CB, Jakubowski JA. The pathophysiology and clinical relevance of platelet heterogeneity. Blood 1988; 72 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 11 Peralta R, Thani HA, Rizoli S. Coagulopathy in the surgical patient: trauma-induced and drug-induced coagulopathies. Curr Opin Crit Care 2019; 25 (06) 668-674
    CrossrefPubMedGoogle Scholar
  • 12 Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol 2014; 89 (02) 228-232
    CrossrefPubMedGoogle Scholar
  • 13 White RH, McKittrick T, Hutchinson R, Twitchell J. Temporary discontinuation of warfarin therapy: changes in the international normalized ratio. Ann Intern Med 1995; 122 (01) 40-42
    CrossrefPubMedGoogle Scholar
  • 14 Quinlan DJ, Eikelboom JW, Weitz JI. Four-factor prothrombin complex concentrate for urgent reversal of vitamin K antagonists in patients with major bleeding. Circulation 2013; 128 (11) 1179-1181
    CrossrefPubMedGoogle Scholar
  • 15 Hofer S, Schlimp CJ, Casu S, Grouzi E. Management of coagulopathy in bleeding patients. J Clin Med 2021; 11 (01) 1
    CrossrefPubMedGoogle Scholar
  • 16 Wojciechowski VV, Calina D, Tsarouhas K. et al. A guide to acquired vitamin K coagulopathy diagnosis and treatment: the Russian perspective. Daru 2017; 25 (01) 10
    CrossrefPubMedGoogle Scholar
  • 17 Yazer MH. The how's and why's of evidence based plasma therapy. Korean J Hematol 2010; 45 (03) 152-157
    CrossrefPubMedGoogle Scholar
  • 18 Hellstern P. Production and composition of prothrombin complex concentrates: correlation between composition and therapeutic efficiency. Thromb Res 1999; 95 (4, Suppl 1): S7-S12
    CrossrefPubMedGoogle Scholar
  • 19 Rowe AS, Mahbubani PS, Bucklin MH, Clark CT, Hamilton LA. Activated prothrombin complex concentrate versus plasma for reversal of warfarin-associated hemorrhage. Pharmacotherapy 2016; 36 (11) 1132-1137
    CrossrefPubMedGoogle Scholar
  • 20 Kopko PM, Bux J, Toy P. Antibodies associated with TRALI: differences in clinical relevance. Transfusion 2019; 59 (03) 1147-1151
    PubMedGoogle Scholar
  • 21 Levy JH, Tanaka KA, Dietrich W. Perioperative hemostatic management of patients treated with vitamin K antagonists. Anesthesiology 2008; 109 (05) 918-926
    CrossrefPubMedGoogle Scholar
  • 22 Sarode R, Milling TJ, Refaai MA. et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding. Circulation 2013; 128 (11) 1234-1243
    CrossrefPubMedGoogle Scholar
  • 23 Chai-Adisaksopha C, Hillis C, Siegal DM. et al. Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thromb Haemost 2016; 116 (05) 879-890
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Rose DK, Bar B. Direct oral anticoagulant agents: pharmacologic profile, indications, coagulation monitoring, and reversal agents. J Stroke Cerebrovasc Dis 2018; 27 (08) 2049-2058
    CrossrefPubMedGoogle Scholar
  • 25 Chen A, Stecker E. A Warden B, Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc 2020; 9 (13) e017559
    CrossrefPubMedGoogle Scholar
  • 26 Steffel J, Verhamme P, Potpara TS. et al; ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39 (16) 1330-1393
    CrossrefPubMedGoogle Scholar
  • 27 Kumar S, Lim E, Covic A. et al. Anticoagulation in concomitant chronic kidney disease and atrial fibrillation: JACC review topic of the week. J Am Coll Cardiol 2019; 74 (17) 2204-2215
    CrossrefPubMedGoogle Scholar
  • 28 Yeung LYY, Sarani B, Weinberg JA, McBeth PB, May AK. Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation. Trauma Surg Acute Care Open 2016; 1 (01) e000022
    CrossrefPubMedGoogle Scholar
  • 29 Godier A, Fontana P, Motte S. et al; French Working Group on Perioperative Hemostasis (GIHP). Management of antiplatelet therapy in patients undergoing elective invasive procedures: proposals from the French Working Group on perioperative hemostasis (GIHP) and the French Study Group on thrombosis and hemostasis (GFHT). In collaboration with the French Society for Anesthesia and Intensive Care (SFAR). Arch Cardiovasc Dis 2018; 111 (03) 210-223
    CrossrefPubMedGoogle Scholar
  • 30 James RF, Palys V, Lomboy JR, Lamm Jr JR, Simon SD. The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage. Neurosurg Focus 2013; 34 (05) E6
    CrossrefPubMedGoogle Scholar
  • 31 Yorkgitis BK, Ruggia-Check C, Dujon JE. Antiplatelet and anticoagulation medications and the surgical patient. Am J Surg 2014; 207 (01) 95-101
    CrossrefPubMedGoogle Scholar
  • 32 Grzegorski T, Andrzejewska N, Kaźmierski R. Reversal of antithrombotic treatment in intracranial hemorrhage – a review of current strategies and guidelines. Neurol Neurochir Pol 2015; 49 (04) 278-289
    CrossrefPubMedGoogle Scholar
  • 33 Hayakawa M. Pathophysiology of trauma-induced coagulopathy: disseminated intravascular coagulation with the fibrinolytic phenotype. J Intensive Care 2017; 5: 14
    CrossrefPubMedGoogle Scholar
  • 34 Walsh M, Fritz S, Hake D. et al. Targeted thromboelastographic (TEG) blood component and pharmacologic hemostatic therapy in traumatic and acquired coagulopathy. Curr Drug Targets 2016; 17: 954-970
    CrossrefPubMedGoogle Scholar
  • 35 Chang R, Kerby JD, Kalkwarf KJ. et al; PROPPR Study Group. Earlier time to hemostasis is associated with decreased mortality and rate of complications: results from the Pragmatic Randomized Optimal Platelet and Plasma Ratio trial. J Trauma Acute Care Surg 2019; 87 (02) 342-349
    CrossrefPubMedGoogle Scholar
  • 36 Hayashi H, Beppu T, Shirabe K, Maehara Y, Baba H. Management of thrombocytopenia due to liver cirrhosis: a review. World J Gastroenterol 2014; 20 (10) 2595-2605
    CrossrefPubMedGoogle Scholar
  • 37 DeAngelis GA, Khot R, Haskal ZJ. et al. Bleeding risk and management in interventional procedures in chronic liver disease. J Vasc Interv Radiol 2016; 27 (11) 1665-1674
    CrossrefPubMedGoogle Scholar
  • 38 Harrison MF. The misunderstood coagulopathy of liver disease: a review for the acute setting. West J Emerg Med 2018; 19 (05) 863-871
    CrossrefPubMedGoogle Scholar
  • 39 Agarwal B, Wright G, Gatt A. et al. Evaluation of coagulation abnormalities in acute liver failure. J Hepatol 2012; 57 (04) 780-786
    CrossrefPubMedGoogle Scholar
  • 40 Stravitz RT, Lisman T, Luketic VA. et al. Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography. J Hepatol 2012; 56 (01) 129-136
    CrossrefPubMedGoogle Scholar