Coagulopathies in Orthopaedics
| Autor: | Colin G. Crosby, Christopher M. Stutz, Lynda O'Rear, Maria E. Tamborski, Jonathan G. Schoenecker, Kevin R. O'Neill, Clinton J. Devin |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class medicine Coagulation testing Humans Coagulation (water treatment) Orthopedic Procedures Orthopedics and Sports Medicine Intensive care medicine Blood Coagulation Musculoskeletal System Inflammation Disseminated intravascular coagulation Prothrombin time medicine.diagnostic_test business.industry Anticoagulant Anticoagulants General Medicine Blood Coagulation Disorders medicine.disease Surgery Systemic inflammatory response syndrome Venous thrombosis Wounds and Injuries business Partial thromboplastin time |
| Zdroj: | Journal of Orthopaedic Trauma. 27:236-241 |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0b013e318269b782 |
| Popis: | Orthopaedic patients are at risk for developing pathologic imbalances of coagulation factors characterized by phases of both hypocoagulability and hypercoagulability. Complications from "hypocoagulability" include life-threatening hemorrhage, wound hematoma, and poor wound healing. Complications due to "hypercoagulability" include deep venous thrombosis, pulmonary embolus, and disseminated intravascular coagulation. In addition, coagulation imbalance that favors the production of procoagulant factors may lead to excessive inflammation and contribute to systemic inflammatory response syndrome, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and death. Optimally, the goal of individualized treatment of coagulopathies in orthopaedic patients should be to achieve efficient healing while avoiding the morbidities associated with imbalance of coagulation and inflammation. Such individualized and time-sensitive measures of coagulation status require rapid, accurate, qualitative, and quantitative assessment of the critical balance of the coagulation system. Commonly used coagulation tests (prothrombin time and activated partial thromboplastin time) are incapable of determining this balance. An alternative to is to perform thrombin generation assays. The greatest advantage of thrombin generation assays over traditional coagulation tests is their ability to detect hypercoagulability, the balance of procoagulant and anticoagulant factors, and the effect of all pharmaceutical anticoagulants. Further clinical investigations are warranted to develop and refine the thrombin generation assays to help predict clinical complications related to coagulation imbalances. In addition, future testing will help define the prothrombotic period allowing for appropriate initiation and cessation of anticoagulant pharmaceuticals. These subsequent studies have the potential to allow the development of a real-time coagulation monitoring strategy that could have paramount implications in the management of postoperative patients. |
| Databáze: | OpenAIRE |
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