Clotting disorders

Uncommon as a secondary event in critically ill patients as they tend to be auto-anticoagulated. The risk of major venous thrombosis increases with long term immobility and paralysis, and in specific pro-thrombotic conditions such as pregnancy, thrombotic thrombocytopenic purpura, SLE (lupus anticoagulant), sickle cell crisis, hyperosmolar diabetic coma.

Disseminated intravascular coagulation is associated with microvascular clotting, a consumption coagulopathy and increased fibrinolysis.

Clotting of extracorporeal circuits, e.g. for renal replacement therapy, may be due to (i) mechanical obstruction to flow, e.g. kinked catheter, (ii) inadequate anticoagulation or (iii) in severe illness, a decrease in endogenous anticoagulants (e.g. antithrombin III); this may result in circuit blockage despite a coexisting thrombocytopenia and/or coagulopathy.

Axillary vein or subclavian vein thrombosis may result from indwelling intravenous catheters.

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