Monitoring of blood clotting during bleeding

Abstract

Background. The risk of bleeding and thrombotic events should be weighed before, during and after surgery. To facilitate this process, it is advisable to ask yourself the following questions: if we start the operation now, will the bleeding develop? If we delay the intervention, will a thrombotic event occur? Are the patient’s antithrombotic drugs effective? Objective. To describe the blood coagulation monitoring system. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Coagulopathy can be congenital and acquired, the latter including iatrogenic. The causes of congenital coagulopathies include hemophilia, von Willebrand factor deficiency, thrombocytopenia, and antiphospholipid syndrome. Antiplatelet drugs and direct oral anticoagulants are the main causes of iatrogenic coagulopathies. Other causes of acquired coagulopathies include hemostasis failure, disseminated intravascular coagulation syndrome, and post-surgical coagulopathies of various types. In order to treat bleeding in coagulopathies, desmopressin, tranexamic acid, coagulation factors, and protamine are administered. Laboratory tests needed to detect coagulopathies include prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, fibrinogen levels, and coagulation factors. The limitations of these tests include their non-dynamic nature, lack of ability to predict the risk of bleeding, time and financial costs, inability to understand the pathophysiological mechanism of bleeding. There may also be an error in the analysis due to the addition of citrate and calcium to the samples. Rapid tests to assess the hemostasis system include determination of activated coagulation time, Hepcon heparin monitoring system, thromboelastography and platelet mapping, platelet aggregometry using multiple electrodes, rotational thromboelastometry, and sonoreometry. Conclusions. 1. For best results, coagulopathy should be anticipated, detected, and treated in a timely manner. 2. The strength of blood clots depends on platelets and fibrinogen. 3. It is advisable to use rapid tests to assess hemostasis and repeat them regularly, as bleeding and blood clotting are dynamic processes. 4. The effects of hemodilution, acid-base balance and temperature should be kept in mind.