3.10.6 - Haemostasis, Coagulopathies and the Bleeding Patient

Summary

Key Learning Points

1. 1. Coagulation is a tightly regulated process controlled by interactions between the vessel, platelets, clotting factor enzymes, co-factors and inhibitors, aimed at stopping bleeding from damaged vessels.

2. 2. Coagulation involves initiation, activation and propagation of platelet activity to generate a thrombin burst which polymerises fibrinogen to fibrin, plugging the vessel wall.

3. 3. Coagulopathy is common in critically ill patients and is associated with increased illness severity and mortality.

4. 4. The underlying cause of coagulopathy must be diagnosed and treated, whilst avoiding the unnecessary correction of laboratory test results, unless there is clinical bleeding or a surgical procedure required.

5. 5. Disseminated intravascular coagulopathy is most commonly triggered by sepsis, leading to the consumption of clotting factors and platelets, which, in turn, causes bleeding and microthrombotic events. Treatment must be focused upon the underlying condition.