PDF(Pubmed)
Abstract：
Coagulation disorders in critically ill patients presenting with bleeding can be multicausal. The drugs applied can interfere and impair the coagulation cascade. Point-of-care (POC) coagulation assays may resolve difficult therapeutic situations in critical illness. We report on a 73-year-old critically ill male patient with massive hematuria after bladder lithotripsy. The patient was on low molecular weight heparin therapy due to recent pulmonary embolism. He was subjected to repeated surgical hemostasis which was ineffective despite massive transfusion protocol and normal standard coagulation profile. Additional POC coagulation assays were obtained and were indicative of platelet dysfunction. We revised his medical therapy and suspected the possible drug influence on platelet aggregation. After discontinuation of target drug, platelet aggregation increased whereas hematuria stopped. Coagulation disorders in intensive care unit patients are often multifactorial. Standard laboratory tests are unreliable in complex refractory bleeding and may result in inappropriate therapeutic decisions. Stepwise approach with assessment of clinical parameters, present therapy, and a combination of POC coagulation tests is the key to optimal therapeutic management.
摘要：
出现出血的危重患者的凝血障碍可能是多绝经期的。所应用的药物可干扰和损害凝血级联。现场护理（POC）凝血测定可以解决危重病中的困难治疗情况。我们报告了一名73岁的危重男性患者，在膀胱碎石术后出现大量血尿。由于最近的肺栓塞，该患者正在接受低分子量肝素治疗。尽管进行了大量输血方案和正常的标准凝血曲线，但他仍经历了反复的手术止血，但无效。获得了另外的POC凝血测定并且指示血小板功能障碍。我们修改了他的药物治疗，怀疑药物可能对血小板聚集有影响。在停止目标药物后，血小板聚集增加，而血尿停止。重症监护病房患者的凝血障碍通常是多因素的。在复杂的难治性出血中，标准实验室检查不可靠，可能导致不适当的治疗决定。评估临床参数的逐步方法，目前的治疗，和POC凝血测试的组合是最佳治疗管理的关键。
