Bleeding and Coagulopathies in Critical Care

Copyright © 2014 Massachusetts Medical Society. The definition of coagulopathy is “a condition in which the blood’s ability to clot is impaired.” However, for some clinicians, the term also covers thrombotic states, and because of the complexity of the hemostatic pathways, the two conditions can exist simultaneously. Some practitioners would consider that mildly abnormal results on coagulation screening without bleeding can also indicate a coagulopathy. This review is confined to the original definition of coagulopathy as given above. Such states are common in patients in the intensive care unit (ICU) and require a clinicopathological approach to ensure that the correct diagnosis is made and the appropriate treatment administered. The lack of evidence for managing coagulopathies in critical care is striking. This review will highlight selected areas in which there is high-quality evidence and at the same time point out areas for which there is poor evidence. In the latter case, there is little consensus on management.