What is an Coagulation?
Coagulation is a dynamic process and the understanding of the blood coagulation system has evolved over the recent years in anaesthetic practice. Although the traditional classification of the coagulation system into extrinsic and intrinsic pathway is still valid, the newer insights into coagulation provide more authentic description of the same. Normal coagulation pathway represents a balance between the pro coagulant pathway that is responsible for clot formation and the mechanisms that inhibit the same beyond the injury site. Imbalance of the coagulation system may occur in the perioperative period or during critical illness, which may be secondary to numerous factors leading to a tendency of either thrombosis or bleeding. A systematic search of literature on PubMed with MeSH terms ‘coagulation system, haemostasis and anaesthesia revealed twenty eight related clinical trials and review articles in last 10 years. Since the balance of the coagulation system may tilt towards bleeding and thrombosis in many situations, it is mandatory for the clinicians to understand physiologic basis of haemostasis in order to diagnose and manage the abnormalities of the coagulation process and to interpret the diagnostic tests done for the same.
- Our approach to treatment of thrombosis begins with finding out why the blood clot occurred, removing any identifiable risk factors, and sometimes using blood thinners called anti-coagulants to prevent further unwanted clotting. In general, our approach to thrombosis follows the published guidelines of the American College of Chest Physicians. We try to minimize the time a child is on anticoagulation medication while at the time making sure we reduce the risk of the clot getting bigger or coming back.
- In some cases, the body does not have enough of the substances it needs to form a blood clot. This can happen because either the individual was not born with enough of these substances (hereditary) or they have a condition that keeps clotting from happening (acquired). Often, patients who have problems forming a clot are referred to us because of unusual bleeding.
- During the initial visit we try to understand as quickly as possible the patient’s pattern of bleeding, including asking about any family history of bleeding, and any possible causes for an acquired bleeding condition. This helps us to obtain the best tests and discover the cause of the bleeding.
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