الفهرس 
Blood HaemostasisOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
Haemostasis, defined as arrest of bleeding, comes from Greek, haeme meaning blood and stasis meaning to stop .Hemostasis is the physiological process that stops bleeding at the site of an injury while maintaining normal blood flow elsewhere in the circulation
The stress response is the name given to the hormonal and metabolic changes which follow surgery or trauma. This is part of the systemic reaction to surgery which encompasses a wide range of endocrinological, immunological and haematological effects
Hypercoagulable disorders are now diagnosed more frequently than before. These patients are, usually, managed with multiple anticoagulant and antiplatelet medications. Left unmonitored and unevaluated, there can be disastrous haemorrhagic or thrombotic complications. Appropriate perioperative and anaesthetic management of these patients will invite an aetiological diagnosis, severity analysis and the on-going treatment review. Bleeding and neuraxial haematomas can be disastrous complications at times. Associated low platelet count may need modification in the anticoagulant doses. Available evidence based guidelines will help to offer more precise therapeutic options
The perioperative management of patients who are receiving vitamin K antagonists (VKAs) or antiplatelet drugs and require a surgical or invasive procedure presents a dilemma for practicing clinicians. This clinical problem affects an estimated 25.000 patients annually in North America alone and is of interest to a wide spectrum of clinicians, including internists, surgeons, anesthetists, family physicians, and dentists
Managing antithrombotic agents in patients undergoing surgery is a common clinical challenge, often requiring temporary interruption of treatment prior to the procedure. Antithrombotic agents can generally be grouped into anticoagulants and antiplatelet agents. Anticoagulants include warfarin, unfractionated heparin (UFH), low-molecular weight heparin (LMWH), fondaparinux, direct thrombin inhibitors (DTI) and direct Xa inhibitors. Antiplatelet agents include aspirin and other nonsteroidal anti-inflammatory drugs (NSAID), thienopyridines (e.g., clopidogrel, prasugrel, ticlopidine), phosphodiesterase inhibitors (e.g., dipyridamole, cilostazol) and glycoprotein IIb/IIIa receptor inhibitors (e.g., abciximab, eptifibatide, tirofiban)
Bridging this gap in anticoagulation with rapid-onset and shorter acting anticoagulants like UFH or LMWH has become common practice. In the past decade, LMWH has become an increasingly popular choice because of the practical benefit of subcutaneous administration which allows the “bridging therapy” to be done outside the hospital.
The decision as to which patients should be bridged, and when to stop and restart warfarin and LMWH perioperatively depends on balancing the risk of thrombosis with the risk of bleeding attributed to bridging.