Coagulopathy in the intensive care unit.

Coagulopathy is a potential problem for many critically ill patients, placing them at risk for hemorrhage. Critical illness activates both hemostasis and the inflammatory-immune system, leading to both physiological and potentially pathophysiological responses. Following complex surgery or trauma, patients are at high risk for development of problems such as thrombocytopenia and postoperative bleeding, challenging nurses to recognize and manage these problems. The clinical manifestations of coagulopathy may be obvious or occult, and correlation with the coagulation panel results is a complex process. Transfusion of blood and components has long been an important part of patient management, but is known to put patients at risk for transfusion-related complications. Current clinical practice guidelines provide blood conservation strategies and criteria to guide decisions on transfusion therapy.

Death by clot: acute coronary syndromes, ischemic stroke, pulmonary embolism, and disseminated intravascular coagulation.

Blood clotting is a complex process that controls bleeding when tissues are injured. Unfortunately, this same process is capable of producing life-threatening thrombi in response to pathophysiological events. Blood clots may form in large and small vessels in response to triggers from disrupted vessel walls, inflammatory cells, cytokines, and other pathology. Platelet-rich clots can impair circulation to the myocardium and brain, leading to acute coronary syndromes and stroke. Erythrocyte-rich clots can embolize from the deep veins and threaten the lungs with pulmonary emboli. Microthrombi can block the circulation to tissues and organs in disseminated intravascular coagulation. An understanding of the pathogenesis of these various clotting syndromes directs effective intervention and preventive measures, minimizing the number of deaths by clot.