Bombeli T. , Spahn D.R. British Journal of Anaesthesia

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Presentation transcript:

Updates in perioperative coagulation: physiology and management of thromboembolism and haemorrhage Bombeli T. , Spahn D.R. British Journal of Anaesthesia Volume 93, Issue 2, Pages 275-287 (August 2004) DOI: 10.1093/bja/aeh174 Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 1 Current model of coagulation and fibrinolysis. In vivo the coagulation process is initiated mainly by FVIIa bound to tissue factor (TF; large black arrow), which then activates both FX (1) and FIX (2) (=initiation phase). To increase thrombin generation further, thrombin activates FV, FVIII and FXI in a feedback-loop (3) (=amplification). Continuation of thrombin generation results mainly from the ongoing generation of FXa by FIXa and FVIIIa (=propagation). Maximum thrombin generation occurs only after the formation of fibrin, leading to the formation of FXIIIa, which then crosslinks the fibrin monomers (4) (=stabilization). British Journal of Anaesthesia 2004 93, 275-287DOI: (10.1093/bja/aeh174) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 2 Laboratory evaluation of a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). Antiphospholipid antibody (APA) tests, as mentioned in the aPTT tree, may include lupus anticoagulants, anticardiolipin antibodies and anti-β2-GPI antibodies. Clotting mixing tests are performed to detect acquired neutralizing antibodies (inhibitors) to single coagulation factors. DD=D-dimers; DIC=disseminated intravascular coagulation; Fbg=fibrinogen; TT=thrombin time. British Journal of Anaesthesia 2004 93, 275-287DOI: (10.1093/bja/aeh174) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions