Standardized evaluation of coagulation dysfunction in critically ill patients, see the consensus of Chinese experts!

More than 40% of critically ill patients will develop coagulation dysfunction.

Recommendation 1.

Recommendation 2 Coagulation dysfunction is a pathophysiological state with bleeding tendency caused by decreased blood coagulation ability (recommendation strength A, evidence level IV)

Recommendation 3 Coagulation failure is an emergency state in which the blood's coagulation capacity is insufficient to maintain the normal flow of the body's own blood (recommendation strength A, evidence level IV)

Recommendation 4 Disseminated intravascular coagulation is a systemic disease secondary to underlying pathogenic factors and characterized by extensive activation of intravascular coagulation mechanisms (recommendation strength A, evidence level II)

Recommendation 5 Evaluation of coagulation dysfunction in critically ill patients should pay attention to the patient's underlying disease, medication history, age, gender and weight (recommendation strength A, evidence level II)

Recommendation 6 It is recommended to use blood smear for peripheral blood morphological examination to assist in the diagnosis of coagulation disorders in critically ill patients (recommendation strength A, evidence level IV)

MDS.

Figure Flow chart of peripheral blood morphological examination in critically ill patients with coagulation dysfunction

Recommendation 7 Make full use of routine coagulation tests and correction tests to screen for coagulation disorders in critically ill patients (recommendation strength A, evidence level IV)

Recommendation 8: Viscoelastic coagulation test is recommended as a routine diagnostic method for coagulation disorders in critically ill patients (recommendation strength A, evidence level II)

LY30%.

Figure Standard procedure for the evaluation of coagulation disorders with the common thromboelastometry test

ACT.

Figure Standard procedure of coagulation and platelet function analyzer to assess coagulation disorders

Recommendation 9 It is recommended to use a combination of conventional coagulation test and viscoelasticity test to diagnose coagulation disorders in critically ill patients (recommendation strength A, evidence level IV)

PT.
Prothrombin time; APTT.
Activated partial thromboplastin time; TEG.
Thromboelastometry; Fib.
Fibrinogen; FFMA.
Maximum amplitude

Fig.
Standard procedure of conventional coagulation test combined with viscoelasticity test to evaluate coagulation dysfunction

Recommendation 10 It is recommended to use new coagulation molecular markers to judge the type and prognosis of coagulation dysfunction in critically ill patients (recommendation strength A, evidence level III)

Recommendation 11: It is recommended to use the anti-Xa activity assay to evaluate the relative concentration of heparin drugs (recommendation strength A, evidence level III)

Recommendation 12 It is recommended to use ISTH-DIC and CDSS-DIC scoring systems to diagnose DIC (recommendation strength A, evidence level II)

DIC/SIC diagnostic criteria

The above content is excerpted from: Song Jingchun, Zhang Wei, Zhang Lei, et al.
Chinese expert consensus on standardized assessment of coagulation dysfunction in critically ill patients [J].
PLA Medical Journal, 2022, 47(2): 107-117.

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