Risk estimation and management of coagulopathy in ICU patients in need of an invasive procedure

Coagulation abnormalities have a high prevalence in critically ill patients. The most commonly used tests to assess coagulation status include assessment of the platelet count, prothrombin time, fibrinogen and d-dimer. However, as these tests do not reflect in vivo haemostatic potential, their ability to assess a potential risk of bleeding is limited. Viscoelastic tests evaluate the whole process of clot formation and degradation, but their value in the assessment of bleeding risk remains to be established. Despite their limitations, increased prothrombin time/ international normalised ratio values or decreased platelet counts are the most important reasons to prophylactically administer plasma or platelets to critically ill patients prior to undergoing an invasive procedure. However, evidence that prophylactic correction of coagulation abnormalities prevents intervention-related bleeding complications is limited. In this narrative review, we discuss the assessment of bleeding risk and management of coagulopathy in critically ill patients in need of an invasive procedure. A practical recommendation is given.