№ 12General Questions19 min read
Coagulopathies, thrombosis prophylaxis
1. Big picture
This topic has two opposite but connected surgical problems:
- Bleeding risk: the patient cannot form a stable clot → operative bleeding, hematoma, wound complications, reoperation.
- Thrombosis risk: surgery creates a hypercoagulable state → deep vein thrombosis (DVT), pulmonary embolism (PE), graft thrombosis, stroke, myocardial infarction.
The exam logic is:
Before surgery:
Is the patient likely to bleed?
Is the patient likely to thrombose?
Is the patient taking anticoagulants or antiplatelets?
Can we correct reversible problems?
What prophylaxis is safest?
After surgery:
Bleeding? Hematoma? Drain output?
DVT? PE? Limb ischemia?
Restart anticoagulation/prophylaxis at the correct time.
The key balance:
Too little anticoagulation → DVT/PE/stroke. Too much anticoagulation → bleeding/hematoma/reoperation.
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