PERIOPERATIVE COAGULATION DISORDERS

Detaljnom prijeoperacijskom obradom bolesnika mogu se identifi cirati poremećaji koagulacije i modifi cirati rizici prije kirurškog zahvata. Prijeoperacijski preporučuje se korištenje standardiziranog upitnika koji sadrži upite bolesniku o sklonosti epistaksi, pojavi hematoma, krvarenja u zglobove, gastrointestinalnom krvarenju, postoperativnom krvarenju, postpartalnom krvarenju i slično. Ovisno o procjeni zdravstvenog stanja bolesnika i opsežnosti kirurškog zahvata (operacijskom riziku) postoje preporuke o prijeoperativnim laboratorijskim testovima. U današnje vrijeme mnogi bolesnici kojima predstoji kirurški zahvat, elektivni ili hitni, koriste lijekove koji djeluju na zgrušavanje krvi. Kako bi bolesnike liječili optimalno potrebno je balansirati između rizika od krvarenja i tromboembolijskih komplikacija, kako bi se poboljšao ishod bolesnika. Poseban pristup je potreban kod intraoperativnog masivnog krvarenja i kod politraumatiziranih bolesnika. Ključan čimbenik dobrog ishoda bolesnika s perioperativnom koagulopatijom je iskusan anesteziolog koji dobro poznaje patofi ziologiju koagulopatije kod pojedinih bolesti i stanja te djelovanje raznih lijekova na koagulacijski sustav.Precise preoperative management of patients can identify coagulation disorders and risks prior to operative surgery, so it can be modifi ed. The use of a standardized questionnaire is preoperatively recommended and, depending on the American Society of Anesthesiologists status and the extent of surgical procedure, there are recommendations for preoperative laboratory tests. Nowadays, many patients undergoing a surgical procedure, elective or urgent, use drugs that act on blood clotting. In order to treat patients optimally, it is necessary to balance the risk of bleeding and thromboembolic complications. Specifi c approach is needed in case of intraoperative massive bleeding and in patients with polytrauma. A key factor for good outcome of patients with perioperative coagulopathy is an experienced anesthesiologist who understands the pathophysiology of coagulopathy in particular diseases and conditions, as well as the effects of various drugs on the coagulation system