preoperative health status

preoperative health status

BOX 1-22

Management of Patient with a Coagulopathy

1. Defer surgery until a hematologist is consulted about
the patient’s management.
2. Obtain baseline coagulation tests as indicated (prothrombin
time, partial thromboplastin time, Ivy
bleeding time, platelet count) and a hepatitis screen.
3. Schedule the patient in a manner that allows surgery
soon after any coagulation-correcting measures have
been taken (aftE’,( platelet transfusion, factor repla.cement,
or aminocaproic acid administration).
4. Augment clotting during surqery with the use of top-
• ical coagulation-promoting substances, sutures, and
well-placed pressure packs.
5. Monitor the wound for 2 hours to ensure that a good
initial dot forms.
6. Instruct the patient in ways to prevent dislodgment
of the clot and in what to do should bleeding restart.
7. Avoid prescribing nonsteriodal antiinflammatory
drugs (NSAIDs).
8. Take hepatitis precautions during surgery.

·Patients with severe coagulopathies who require major surgery should be hospitalized.

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