This site provides an overview of acquired coagulopathy in the postoperative setting, and specifically explores the less-recognized phenomenon of iatrogenic immune-mediated coagulopathy (IMC) in surgical patients. This site is intended for healthcare professionals.

What is a coagulopathy?

Coagulopathy stems from defective function in one or more elements of the inherent clotting mechanisms, and is distinct from hemorrhage related to direct vascular breach during surgery or other pathologies.

Coagulopathy is defined as a disease affecting the coagulability of blood, including:

Hemorrhagic or thrombotic disorders: These disorders generally involve excessive bleeding (hemorrhage) or excessive clot formation leading to vascular obstruction (thrombosis).
Inherited or acquired disorders: Inherited disorders are congenital conditions that individuals are born with and are transmitted by inheritance. Some examples include: hemophilia and von Willebrand disease. Acquired disorders are conditions that are not congenital but have developed after birth. Some causes include: liver disease, vitamin K deficiency, disseminated intravascular coagulation and immune-mediated coagulopathy.

Postoperative coagulopathy is a complex medical disorder with a variety of causes and health effects. Identifying a coagulopathy requires assessments of the components and function of normal coagulation. A thorough patient assessment and medical history are also required, and consultation with specialists may be needed to diagnose and develop a management plan. This site provides resources and information, but is not intended to replace appropriate medical evaluation and judgment.

ACQUIRED POST-SURGICAL COAGULOPATHY

Acquired Post-Surgical Coagulopathy
This section also covers immune-mediated platelet disorders, specific factor inhibitors, and a summary of the historic parallels between HIT and bovine thrombin-associated coagulopathy.

EXPERT CORNER

Expert Webinar
Provides an overview of postoperative coagulopathies, with a particular focus on IMC.
Expert Column
Jeffrey Lawson, MD, PhD, discusses postoperative coagulopathy, with particular emphasis on IMC.
Expert Article
Immune-mediated coagulopathy — consensus and safety.

RESOURCES

Postoperative IMC Overview
A downloadable overview of immune-mediated coagulopathy in the post-surgical setting.
Selected Literature
A list of relevant literature associated with post-surgical IMC.

CLINICAL CONSIDERATIONS WITH HEMORRHAGIC IMC

Clinical Considerations With Hemorrhagic IMC
This section covers diagnostic challenges, differential diagnosis, diagnostic tools, and management considerations for hemorrhagic IMC.

References:

Zimmerman LH. Causes and consequences of critical bleeding and mechanisms of blood coagulation. Pharmacotherapy. 2007;
27(9, pt 2):45S-56S.

Dagi TF. The management of postoperative bleeding. Surg Clin North Am. 2005;85(6):1191-1213.

Ness P, Creer M, Rodgers GM, et al; the Recognition, Evaluation and Treatment of Acquired Coagulopathy Consensus (RETACC) Panel. Building an immune-mediated coagulopathy consensus: early recognition and evaluation to enhance post-surgical patient safety. Patient Saf Surg. 2009;3(1):8.