Disorders of coagulation

Timely recognition and management of hemorrhage and thrombosis is fundamental to surgical critical care. Bleeding is a potential complication of almost every surgical procedure, and when appropriately anticipated, it can be managed with relative ease. The risk of venous thromboembolism is high postsurgery, but frequently can be reduced dramatically with appropriate prophylactic measures. This chapter reviews aspects of the pathophysiology of bleeding and thrombosis that are important to the critical care surgeon. By way of definition, the term “hemostasis” is used in reference to the normal physiologic (and usually desirable) blood clotting response to breaching of blood vessel integrity. Thrombosis is a term that refers to the pathologic (and therefore undesirable) response of the coagulation system to some form of insult, whether recognized or not.