Essential Guide to Blood Coagulation

Description

This concise book distils the most clinically up-to-date information on thrombotic and bleeding disorders, including the latest treatment strategies, for key conditions and diseases. Essential Guide to Blood Coagulation covers both the stable and the acute stages of hereditary and acquired bleeding and thrombotic disorders.

Faced with a bleeding patient, it may be difficult to determine whether blood loss is due to a local factor, or an underlying hemostatic defect. There are a range of laboratory tests which can be performed to identify the cause of bleeding in a patient. This book highlights the tests that can be used in the laboratory to aid diagnosis.

Essential Guide to Blood Coagulation has been updated to include the new anticoagulants and now has a dedicated chapter on antiplatelet drugs. This invaluable guide will help all those treating patients to expand their knowledge of hemostatic disorders.

Contents

List of contributors
Preface
Abbreviations

PART 1: GENERAL HEMOSTASIS

1 Schematic presentation of the hemostatic system, 3
Nils Egberg

2 Proposals for sampling instructions, 6
Margareta Blombäck and Nils Egberg

• Points to note prior to sampling, 6
• Sampling time and patient preparation, 7
• Referrals for coagulation analyses, 8
• Sampling, 8
• Technique, 9

For DNA investigation (genetic analyses), 10

3 Laboratory investigations, 11
Jovan P. Antovic, Liselotte Onelöv, and Nils Egberg

• Nomenclature, 11
• Reference intervals for laboratory investigations, 13
• Screening analyses, 13
• Special analyses, 20
• Markers of coagulation activation (hypercoagulation markers), 29
• DNA analyses, 29
• Global hemostatic assays and bedside methods, 31
• Useful components in research studies, 32
• Platelet-activating predictors, 35

PART 2: BLEEDING DISORDERS

4 Hereditary bleeding disorders, 41
Margareta Holmström and Lars Göran Lundberg

• General remarks about hemophilia A and B, 41
• General remarks about von Willebrand disease, 42
• Factor concentrates used for treatment of hemophilia A and B and VWD in Sweden in 2012, 43
• Treatment strategy in severe forms of hemophilia and VWD, 44
• Recommendations for desired initial plasma concentrations at different types of bleedings, 45
• Surgery in patients with bleeding disorders, 47
• Tooth extraction in a hemophilia patient, 47
• Caution in patients with bleeding disorders, 48
• Treatment principles for different types of bleeding disorders (severe, moderate, and milder forms of hemostatic defects), 49
• Rare bleeding disorders, 51
• Blood sampling in bleeding disorders, 54
• Bleeding risk charts, 54

5 Critical bleeding, 56
Maria Bruzelius, Anna Ågren, and Hans Johnsson

• Introduction, 56
• Definition of massive bleeding, 56
• Transfusion coagulopathy, 56
• Recommendations to obtain optimal hemostasis, 57
• Choice of plasma, 58
• Local procedures, 59
• Additional treatment, 59
• Fibrinogen concentrate, 59
• Prothrombin-complex concentrate (PCC), 59
• Recombinant factor VIIa, 59
• Concentrates of other coagulation factors, 60
• Cryoprecipitates, 60
• Tranexamic acid, 60
• Desmopressin, 60
• Local hemostatic drugs, 60
• Complicating factors, 61
• Ongoing treatment with antiplatelet, and anticoagulant drugs, 61

6 Investigation of increased bleeding tendency, 62
Margareta Holmström and Lars Göran Lundberg

• Introduction, 62
• Diagnosis, 62
• Reasons for pathologic screening analyses and further actions, 64
• Causes of thrombocytopenia, 64
• Causes of prolonged activated partial thromboplastin time, 65
• Causes of elevated PT(INR), 66
• Investigation of bleeding tendency: practical aspects, 66

PART 3: THROMBOEMBOLIC DISORDERS

7 Venous thrombosis and pulmonary embolism, 71
Anders Carlsson

• Introduction, 71
• Venous thrombosis, 72
• Pulmonary embolism, 75
• Primary prophylaxis against VTE, 91

8 Investigations of thromboembolic tendency, 94
Margareta Holmström

• Introduction, 94
• Venous thromboembolism, 95
• Arterial thromboembolism, 96
• Disseminated intravascular coagulation, 96

9 Heart disease, 97
Håkan Wallen and Rickard Linder

• Ischemic heart disease, 97
• Atrial fibrillation, 102
• Cardiac valve prosthesis, 103
• New oral anticoagulants in the treatment of heart disease, 104

10 Antiplatelet drug therapy and reversal of its effects, 105
Håkan Wallen, Hans Johnsson, and Bo-Michael Bellander

• Introduction, 105
• ASA, 105
• ADP (P2Y12) receptor antagonists, 106
• GPIIb/IIIa receptor antagonists, 106
• Phosphodiesterase inhibitors and other antiplatelet compounds, 108
• Combined antithrombotic treatment, 108
• Benefi t–risk assessment, 108
• Platelet transfusion, 109

11 New oral anticoagulants: Focus on currently approved oral factor Xa and Thrombin inhibitors, 111
Rickard E. Malmström and Hans Johnsson

• Clinical pharmacology of NOACs, 111
• Possibility of and need for therapeutic monitoring of NOACs, 114
• Clinical aspects of NOACs, 114
• Results of clinical trials, 116
• Some characteristics of the individual NOACs, 118
• Considerations to be taken when using NOACs in some emergency situations

12 Stroke and transient ischemic attack, 121
Nils Wahlgren and Mia von Euler

• Antithrombotic secondary stroke prevention, 121
• Atrial fibrillation and TIA or stroke, 122
• Thrombolysis in stroke, 122
• Cerebral venous thrombosis and dissection of precerebral arteries, 123
• Recurrent TIA, 124
• Prophylactic treatment against DVT and PE, 124

13 Peripheral artery surgery, 125
Jesper Swedenborg

• Prophylaxis against reocclusion in peripheral vascular surgery or percutaneous transluminal angioplasty (PTA), 125
• Peri- and postoperative treatment, 125
• Thrombolysis in acute ischemia, 126

PART 4: SPECIAL HEMOSTASIS

14 Hemostasis in obstetrics and gynecology, 129
Katarina Bremme

• Introduction, 129
• Thrombosis during pregnancy, 131
• Heart disease: treatment of women with mechanical heart valve prostheses, 139
• Thromboprophylaxis in obstetrics and gynecology, 140
• Blood sampling in children of women with severe forms of thrombophilia, 148
• Obstetric epidural/spinal analgesia (anesthesia), 148
• Complications during pregnancy, 150
• Postpartum bleeding, 155
• Thromboprophylaxis in legal and spontaneous abortions, 156
• Thromboprophylaxis in gynecologic surgery, 156
• Investigation prior to artificial insemination (IVF), 160
• Investigation in repeated miscarriages, 160
• Investigation in menorrhagia (for treatment see Chapter 4), 161

15 Hemostasis in children, 162
Susanna Ranta and Pia Petrini

• Introduction, 162
• Bleeding disorders in children, 166
• Thromboembolic disorders in children, 172

16 Emergency conditions associated with coagulation: DIC, HIT and TTP/HUS, 182
Jovan P. Antovic and Margareta Holmström

• Disseminated intravascular coagulation, 182
• Heparin-induced thrombocytopenia, 188
• Thrombotic microangiopathies, 190

Index, 191

Author

Jovan P. Antovic and Margareta Blombäck
Department of Molecular Medicine and Surgery, Coagulation Research, Karolinska Institutet; Clinical Chemistry, Karolinska University Hospital,
Stockholm, Sweden