Bleeding and Clotting: Blood and Drugs

Uncontrolled hemorrhage from trauma, surgery, or post-partum is a major cause of death, but more people die from clotting, as heart attacks, strokes, or thromboembolism. The coagulation system underlies this complex interaction between bleeding and clotting. There are numerous blood components, biologicals, and drugs that affect bleeding and clotting; a basic understanding is requisite for successful perioperative care. This chapter provides an essential review of primary and secondary hemostasis and fibrinolysis, conventionally available tests of coagulation, common causes of hemorrhage, and commonly used anticoagulant drugs and platelet inhibitors. Finally, it discusses current concepts of the use of blood components to reverse coagulopathy and the transfusion reactions that can complicate blood therapy.

Keywords: Anticoagulants, Antiplatelet agents, ACT, Clotting, Coagulation testing, Congenital clotting disorders, Fibrinolysis, Hemorrhage, Primary hemostasis, Secondary hemostasis, Thrombosis, Von Willibrands Disease.