Hemostasis and Thrombosis in Critically Ill Patients

Abstract

A large number of critically ill patients will develop hemostasis and thrombosis issues during their clinical course. These problems may vary from excessive blood loss due to a myriad of causes; to widespread intravascular fibrin formation and consequent multiple organ dysfunction as a result of systemic inflammation; to the development of venous thromboembolic complications. Some patients will present with simultaneous bleeding and thrombotic complications, which will render the appropriate treatment even more complex. Both anticoagulant and prohemostatic drugs belong to the most frequently prescribed agents for patients in the intensive care unit (ICU).[1] [2] In addition, in critically ill patients, coagulation abnormalities often occur. A variety of changes, such as thrombocytopenia, prolonged global coagulation tests, reduced levels of coagulation inhibitors, or high levels of fibrin split products, may reflect various disease mechanisms. Also, some patients may have a marked coagulopathy that is not readily revealed by routine coagulation tests. In all cases, a proper differential diagnosis is required, as various underlying causes may require totally different therapeutic approaches. In this issue of Seminars in Thrombosis and Hemostasis, various topics regarding the diagnostic and therapeutic management of hemostasis and thrombosis issues in critically ill patients are discussed.