Coagulation disorders anticoagulants

The hemorrhagic diathesis in patients with coagulation disorders is because of either an abnormaUty of one or more plasma proteins and/or platelets necessary for normal blood coagulation or the spontaneous presence of a circulating anticoagulant. Specific laboratory techniques are required for the precise identification of these disorders. 

Contraindications Hypersensitivity to natural or recombinant hirudins (anticoagulation factors), active bleeding, irreversible coagulation disorders... 

A 73-year-old man with a common cold, who had been taking cucurbicin three tablets daily for more than 1 year, developed a coagulation disorder, with an international normalized ratio (INR) of 2.1, despite a normal albumin concentration and no anticoagulant treatment. His INR improved to 1.4 on treatment with vitamin K, but did not normalize until cucurbicin was withdrawn 1 week later. 

Coagulation disorders result from a decreased number of platelets, decreased function of platelets, coagulation factor deficiency, or enhanced fibrinolytic activity. A series of complex actions and reactions of procoagulant and anticoagulant events regulate blood flow. Maintenance of blood flow involves the interplay of four major components (1) the vessel wall, (2) platelets, (3) the coagulation system, and (4) the fibrinolytic system. 

Phytonadione is a blood modifier/vitamin K. It promotes hepatic synthesis of active prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component (factor IX) and Stuart factor (factor X). It is indicated in the management of coagulation disorders due to faulty formation of factors II, Vn, IX, and X due to vitamin K deficiency or interference with vitamin K activity. Oral/parenteral used for treatment of anticoagulant-induced prothrombin deficiency treatment of hypoprothrombinemia secondary to salicylates or antibacterial therapy, or secondary to obstructive jaundice and biliary fistulas, provided bile salts are also given. Parenteral used for treatment of hypoprothrombinemia secondary to conditions limiting absorption or synthesis of vitamin K prophylaxis and therapy of hemorrhagic disease of the newborn. 

Rectus sheath hematoma is an uncommon and often misdiagnosed condition resulting from either rupture of the epigastric vessels or the rectus muscle itself. The hematoma may be caused by coagulation disorders, trauma, or anticoagulation therapy [65]. Clinically, most patients present with acute... 

In older patients suffering of hypertension or coagulation disorders (due to hepatic or hematological disorders or to anticoagulation therapy), nasal packing and correction of the causative disease are usually sufficient to achieve hemostasis. Failure of initial treatment requires complementary endovascular therapy, usually performed in a less urgent context. 

Screening for coagulation disorders or impairment, as well as for active anticoagulant and/or antiplatelet medication relies first on history and physical exam. Preoperatively, pertinent conditions and medications must be meticulously reviewed. Focused laboratory testing should follow only if indicated (INR, aPTT, fibrinogen level, platelet count platelet fimction testing thromboelas-tometry). 

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