Perioperative Coagulation

Surgical bleeding or coagulopathy?

Before giving products, decide whether the bleeding pattern fits a surgical source, coagulopathy, or both.

A VET result is not a transfusion order

TEG, ROTEM, and Quantra help organize bleeding physiology, but their results must be translated through the clinical situation, surgical field, physiology, local protocol, and reassessment.

Low fibrin contribution to clot strength

Low fibrin-based clot firmness suggests inadequate fibrinogen contribution to clot strength, but the result must be read with the bleeding pattern.

Platelet signal: count, function, and clot strength

Platelet count and platelet contribution to clot strength are related but not identical. Interpret platelet-related signals with fibrin-based measures.

Quantra clot stiffness pattern

Use CS, FCS, and PCS to separate fibrin contribution, platelet contribution, and mixed clot failure before choosing a correction strategy.

Heparin effect or factor deficiency after CPB

After CPB, prolonged clotting time may reflect heparin effect, factor deficiency, dilution, protamine effect, physiology, or timing.

Fibrinolysis: clot breaks down after it forms

A lysis signal matters when clot forms and then breaks down, but fibrinolysis is not the explanation for every bleeding pattern.

Temperature, pH, calcium, and dilution

Hypothermia, acidosis, low calcium, and dilution can prevent product therapy from improving clot formation. Correct physiology and reassess.

ROTEM interpretation guide

Use the ROTEM guide to understand what CT, FIBTEM MCF, EXTEM clot firmness, and lysis signals answer in bleeding patients.

Post-CPB diffuse bleeding

Low fibrin-based clot firmness after CPB raises the question of fibrinogen contribution, platelet contribution, physiology, and surgical source control.

Prolonged clotting time after CPB

A post-CPB clotting time signal may reflect heparin effect, factor deficiency, dilution, protamine effect, physiology, or timing.

Bleeding persists after corrected ROTEM

When the viscoelastic pattern improves but bleeding continues, source control and surgical-field reassessment move back to the center.

Low clot strength after massive bleeding

Massive bleeding can produce mixed fibrinogen, platelet, dilutional, and physiologic problems. Separate the components before choosing treatment.

ROTEM trigger guide

Use ROTEM patterns to organize fibrinogen, clotting time, platelet contribution, and lysis — then reassess after treatment.

TEG 6s trigger guide

Use TEG 6s patterns as clinical signals, not transfusion commands. Read R-time, MA, fibrinogen contribution, and lysis together.

Quantra trigger guide

Use Quantra clot stiffness patterns to separate fibrinogen and platelet contribution while keeping the surgical field in view.

Fibrinogen replacement calculator

Estimate a fibrinogen replacement strategy, then reassess clot firmness and clinical bleeding after treatment.

DOAC perioperative management

Plan DOAC interruption and restart around surgical bleeding risk, renal function, spinal/epidural anesthesia or regional blocks, urgency, and reversal decisions.

Spinal anesthesia and apixaban — does the timing work?

Spinal/epidural anesthesia sets the strict timing requirement. This case asks whether tomorrow's spinal anesthesia is safe after apixaban was taken this morning.

Dabigatran and renal function — when 72 hours is not enough

Dabigatran is renally cleared. Reduced creatinine clearance changes the spinal/epidural timing window and should not be treated like a Xa inhibitor.

High-bleeding-risk surgery on a DOAC — does the washout change?

Surgical bleeding risk and anesthetic technique answer different questions. This case separates high surgical bleeding risk from the DOAC withhold window.