By Christopher M. Loftus
This booklet is an up to date reference on all points of anticoagulation and hemostasis in neurosurgery. After a gap part on uncomplicated rules and drug periods in present use, designated attention is given to coagulation matters correct to all sufferers, not only neurosurgical ones. The assurance comprises, for instance, deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. a number of vital matters particular to neurosurgical perform are then addressed, and a precis of present instructions and most sensible practices is supplied. through bringing jointly the newest wisdom from around the self-discipline, this ebook will function a legitimate foundation for trained determination making in surgical perform. will probably be of day-by-day worth for neurosurgeons and trainees all over the world and also will be of curiosity to emergency room physicians, surgeons often, serious care physicians, neurologists, and medical institution drugs specialists.
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Additional resources for Anticoagulation and Hemostasis in Neurosurgery
Argatroban and Bivalirudin These thrombin inhibitors used for patients with heparin-induced thrombocytopenia can be monitored with the same PTT assay as used for monitoring heparin. 0 fold higher than the laboratory normal, but not more than 90 s. The ACT is employed during cardiac catheterization or cardiac surgery; drug dosing and ACT assessment protocols from the manufacturers should be followed. Warfarin The PT with international normalized ratio (INR) calculation effectively monitors warfarin therapy because it is sensitive to reductions of factors II, VII, and X.
2 Laboratory Assessment of Physiologic and Pathologic Hemostasis Prothrombin Time PT reagents are prepared from recombinant or afﬁnity-puriﬁed tissue factor suspended in phospholipids. Reagents from different manufacturers have differing sensitivities to various factors, warfarin, heparin, and the lupus anticoagulant. When mixed with citrated plasma, the PT reagent plus calcium triggers ﬁbrin polymerization by activating factor VII. The test is most sensitive to factor VII deﬁciencies, moderately sensitive to factor V and X deﬁciencies, sensitive to severe ﬁbrinogen and prothrombin deﬁciencies, and insensitive to deﬁciencies of factors VIII and IX.
Walenga 30 stable response to warfarin therapy. During the ﬁrst week of warfarin therapy, however, the PT results in seconds should be used to monitor therapy. The INR is only validated for stable phase warfarin monitoring and should not be used when evaluating a patient for coagulopathies. The chromogenic factor X assay (not to be confused with the chromogenic anti-factor Xa heparin assay) can be useful when the PT is compromised by lupus anticoagulant, a factor inhibitor, or a coagulation factor deﬁciency.