Coagulopathy

Resident Survival Guide

WikiDoc Resources for Coagulopathy
Articles
Most recent articles on Coagulopathy Most cited articles on Coagulopathy Review articles on Coagulopathy Articles on Coagulopathy in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Coagulopathy Images of Coagulopathy Photos of Coagulopathy Podcasts & MP3s on Coagulopathy Videos on Coagulopathy
Evidence Based Medicine
Cochrane Collaboration on Coagulopathy Bandolier on Coagulopathy TRIP on Coagulopathy
Clinical Trials
Ongoing Trials on Coagulopathy at Clinical Trials.gov Trial results on Coagulopathy Clinical Trials on Coagulopathy at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Coagulopathy NICE Guidance on Coagulopathy NHS PRODIGY Guidance FDA on Coagulopathy CDC on Coagulopathy
Books
Books on Coagulopathy
News
Coagulopathy in the news Be alerted to news on Coagulopathy News trends on Coagulopathy
Commentary
Blogs on Coagulopathy
Definitions
Definitions of Coagulopathy
Patient Resources / Community
Patient resources on Coagulopathy Discussion groups on Coagulopathy Patient Handouts on Coagulopathy Directions to Hospitals Treating Coagulopathy Risk calculators and risk factors for Coagulopathy
Healthcare Provider Resources
Symptoms of Coagulopathy Causes & Risk Factors for Coagulopathy Diagnostic studies for Coagulopathy Treatment of Coagulopathy
Continuing Medical Education (CME)
CME Programs on Coagulopathy
International
Coagulopathy en Espanol Coagulopathy en Francais
Business
Coagulopathy in the Marketplace Patents on Coagulopathy
Experimental / Informatics
List of terms related to Coagulopathy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [3], Sogand Goudarzi, MD [4]

Overview

Coagulopathy is a medical term for a defect in the body's mechanism for blood clotting. While there are several possible causes they generally result in excessive bleeding and a lack of clotting.

Hemophilia is one type of congenital disease characterized by coagulopathy; these are examples of severe lack of blood clotting.

Causes

• Acquired causes of coagulopathy include anticoagulation with warfarin, liver failure, and disseminated intravascular coagulation. Additionally, the haemotoxic venom from certain species of snakes can cause this condition e.g. Bothrops, rattlesnakes and other species of viper.

• Drugs: caspofungin acetate, hydroxyethyl starch, Ixabepilone, Pegasparaginase

Differential Diagnosis of Coagulopathy

Diseases	Clinical manifestations						Para-clinical findings				Gold standard	Additional findings
	Symptoms			Physical examination
							Lab Findings		Imaging
	Symptoms of DVT	Symptoms of Pulmonary Embolism	Symptoms of Myocardial Infarction	Tenderness in extremities	Edema in extremities	Warmth in extremities	PT	aPTT	Doppler ultrasound	Chest CT scan
Antithrombin III deficiency	+	+	-	+	+	+	Normal	Normal Reduces the Increase in PTT after administration of heparin	Evidence of deep vein thrombosis (DVT) Should be used for diagnosis and follow up	Occlusion of brachiocephalic vein Large thrombus in superior vena cava	Decreased plasma antithrombin (AT III) activity	Nephrotic syndrome Decreased inhibition of factor II and Xa Antithrombin is a natural anticoagulant that is lost in the urine
Factor V Leiden mutation	+	+	+	+	+	+	N/A	↑	Recommended to do weekly Proximal DVT is more commonly observed as compared to distal DVT	Pulmonary embolism	N/A	Inactivates factor Va and factor VIIIa
Protein C deficiency	+	+	-	+	+	+	Normal	Normal / ↑	Hypercoagulation Recurrent venous thromboembolism	Venous thromboembolism Pulmonary embolism	Protein C functional assay ELISA assay: may produce false positive result in cross reaction with rheumatoid factor	Factor VIII elevation in acute phase Functional assay should not be performed if patient is on warfarin Purpura fulminans (skin necrosis) could be a form of presentation Risk of thrombotic skin necrosis following warfarin administration
Protein S deficiency	+	+	-	+	+	+	Normal	Normal / ↑	Hypercoagulation Recurrent venous thromboembolism	Pulmonary embolism Thrombosis of superior mesenteric vein	Protein S free antigen assay	When performing the gold standard test, beware of interference from samples positive for Factor V mutation, protein C deficiency and oral anticoagulants (rivaroxaban) Risk of thrombotic skin necrosis following warfarin administration Suspected in patients with a strong family history of VTE Post phlebitic syndrome Fetal loss
Prothrombin gene mutation	+	+	-	+	+	+	↑	N/A	Proximal DVT is more commonly observed as compared to distal DVT	Pulmonary embolism	Detection of mutation using restriction enzyme and PCR DNA testing for prothrombin G20210A mutation	Mutation causes increased production of prothrombin Increased blood levels of prothrombin lead to venous clots in the circulatory system Hormonal oral contraceptive pills can increase the risk of VTE
Disseminated intravascular coagulation (DIC)	+	+	+/-	+	+	+	↑	↑	Portal vein thrombosis is observed in patients with coexistent hepatitis B	Pulmonary embolism	N/A	Elevated fibrin degradation products (D-dimers) Decreased fibrinogen Decreased factor V and VIII Shistocytes (helmet cells) on peripheral blood smear Portal vein thrombosis
Antiphospholipid antibody syndrome	+	+	+/-	+	+	+	N/A	↑	Increased impedance of flow in uterine arteries at 12-20 weeks of gestation	Pulmonary embolism	Antiphospholipid antibody Anticardiolipin antibody Lupus anticoagulant Anti-β2GPI antibody	Both, arterial and venous thrombosis can occur History of spontaneous abortions False positive VDRL Stroke and transient ischemic attack (TIA) are most common forms of presentation of arterial thrombosis