MANAGEMENT OF ACQUIRED COAGULATION DISORDERS IN EMERGENCY AND INTENSIVE-CARE MEDICINE

Coagulation disorders usually confront the emergency physician as blee ding episodes or as abnormalities of laboratory tests. Bleeding has to be treated aggressively, while pathological coagulation tests should be related to a more differentiated diagnosis at first. The most commo n causes of acquired coagulation disorders are liver disease, vitamin K deficiency, and disseminated intravascular coagulation (DIC). More r arely, inhibitors, external factors such as drugs or extracorporeal ci rculation, or other diseases such as amyloidosis are present. Since lo calized hemorrhage is the most common bleeding source in liver disease , endoscopic and surgical therapeutic measures, respectively, are warr anted. Careful and balanced substitution therapy according to laborato ry findings should be initiated simultaneously and should consist of f resh frozen plasma (FFP), which contains all components of the coagula tion system physiologically balanced. Prothrombin complex concentrates should be used in emergency situations only, keeping their potential hazards in mind. Adequate vitamin K substitution is indicated in liver disease as well as in coagulopathy due to vitamin K deficiency. Manag ement of DIC primarily consists of aggressive treatment of the underly ing disease. Substitution therapy is difficult and should be carefully monitored by the adequate laboratory tests. FFP is the adequate sourc e of both procoagulants and inhibitors but may cause certain problems. Heparin therapy can be beneficial but is not recommended generally. A ntithrombin III substitution cannot be assumed as established therapy so far. Inhibitors can lead to bleeding, but the most common inhibitor , lupus anticoagulant, rather predisposes to thrombosis. In bleeding p atients with inhibitors against single clotting factors, treatment con sists of adequate substitution before initiating the diagnostic workup .