Coagulopathy

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Introduction

What is coagulopathy?

Coagulopathy is a condition in which the blood’s ability to clot is impaired. This condition can cause prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures. Coagulopathy can be a primary medical condition or a complication of some other disorder.

The normal clotting process depends on the interplay of various proteins in the blood. Coagulopathy may be caused by reduced levels or absence of blood-clotting proteins, known as clotting factors or coagulation factors. Genetic disorders, such as hemophilia and von Willebrand’s disease, can cause a reduction in clotting factors. Coagulopathy may also occur as a result of dysfunction or reduced levels of platelets (small disk-shaped bodies in the bloodstream that aid in the clotting process). The goal of the clinical evaluation for coagulopathy is to identify the root cause for the bleeding problem.

If you have coagulopathy, your health care provider may help you manage your symptoms with medications or replacement therapy. In replacement therapy, the reduced or absent clotting factors are replaced with proteins derived from human blood or created in the laboratory. This therapy may be given either to treat bleeding that has already begun or to prevent bleeding from occurring.

Coagulopathy may cause uncontrolled internal or external bleeding. Left untreated, uncontrolled bleeding may cause damage to joints, muscles, or internal organs and may be life threatening. Seek immediate medical care (call 911) for serious symptoms, including heavy external bleeding, blood in the urine or stool, double vision, severe head or neck pain, repeated vomiting, difficulty walking, convulsions, or seizures. Seek prompt medical care if you experience mild but unstoppable external bleeding or joint swelling and stiffness.

Symptoms

What are the symptoms of coagulopathy?

Symptoms of coagulopathy include excessive bleeding that may occur spontaneously or following an injury, surgery, or other incident. You may observe excessive bleeding in the mouth or nose or from a cut in the skin. You may experience additional symptoms that could indicate that bleeding is occurring in joints, internal organs, or the brain. The symptoms may vary widely in severity depending on the underlying cause of coagulopathy.

Common symptoms of coagulopathy

You may experience coagulopathy symptoms daily or just once in a while. At times, any of these symptoms can be severe. The following symptoms may occur spontaneously:

  • Abnormal menstrual bleeding
  • Bleeding of the mouth and gums
  • Easy bleeding or bruising
  • Frequent nosebleeds

Symptoms of coagulopathy following injury or procedures

Coagulopathy reduces the blood’s ability to clot. Although some bleeding may be expected after a minor procedure or injury, excessive or extended bleeding is a symptom of coagulopathy. Seek medical attention if heavy bleeding occurs or the bleeding cannot be stopped. Excessive or extended bleeding may occur after:

  • Dental procedures
  • Loss of a tooth
  • Minor trauma or cut
  • Receiving an injection (shot)
  • Surgery

Symptoms of joint bleeding caused by coagulopathy

Coagulopathy may cause bleeding in your elbows, knees, or other joints. The following symptoms may indicate that bleeding is occurring in your joints:

  • Joint feels hot to the touch
  • Joint pain
  • Joint swelling
  • Joint tightness
  • Reduced mobility (range of motion of the joint)

Serious symptoms that might indicate a life-threatening condition

In some cases, coagulopathy may cause bleeding in your brain or internal organs, which can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms of internal bleeding including:

  • Bloody or pink-colored urine (hematuria)
  • Bloody stool (the blood may be red, black, or tarry in texture)
  • Confusion or loss of consciousness for even a brief moment
  • Convulsions or seizures
  • Gradual difficulty walking and speaking, memory loss, tingling, or weakness of extremities
  • Loss of vision or changes in vision
  • Repeated vomiting
Causes

What causes coagulopathy?

Blood clotting requires healthy platelet levels and approximately 20 proteins called clotting factors, or coagulation factors. Coagulopathy occurs when your body is missing or has low levels of one or more of these proteins. It also may occur when platelet levels are low. Reduced or missing clotting factors may be caused by a variety of inherited or acquired disorders.

Genetic causes of coagulopathy

Inherited or genetic disorders causing coagulopathy include:

  • Antithrombin III deficiency

  • Factor II deficiency

  • Factor V deficiency

  • Factor VII deficiency

  • Factor X deficiency

  • Factor XII deficiency

  • Hemophilia A or B

  • Protein C deficiency

  • Protein S deficiency

  • von Willebrand’s disease (hereditary bleeding disorder)

Other causes of coagulopathy

Chronic disease, severe infection, and the use of certain medications can all affect the body’s blood-clotting ability. Examples of conditions that may lead to coagulopathy include:

  • Anticoagulant drug use, such as heparin or warfarin (Coumadin)

  • Disseminated intravascular coagulation (DIC; serious disorder in which the proteins that control blood clotting become abnormally active)

  • Idiopathic thrombocytopenic purpura or thrombotic thrombocytopenic purpura (rare conditions in which small blood clots form throughout the body, resulting in low platelet levels)

  • Long-term use of antibiotics

  • Severe liver disease

  • Viral infection

  • Vitamin K deficiency

What are the risk factors for coagulopathy?

A number of factors increase the risk of developing coagulopathy. Not all people with risk factors will get coagulopathy. Risk factors for coagulopathy include:

  • Heavy menstrual periods in women, in the case of von Willebrand’s disease

  • Male gender, in the case of hemophilia

  • Parent or sibling with coagulopathy disorder

Treatments

How is coagulopathy treated?

Treatment for coagulopathy begins with seeking medical care from your health care provider. To determine whether you have coagulopathy and, if so, its underlying cause, your health care provider will likely draw blood samples for laboratory testing.

The overall goal of coagulopathy treatment is to improve the blood’s ability to clot, but the specific treatment largely depends on the underlying cause. Therapy to improve the blood’s ability to clot may include replacing the missing clotting factors or increasing platelet levels through transfusion.

Medications used to treat coagulopathy

When appropriate, your health care provider may prescribe one or more of the following medications to treat coagulopathy:

  • Aminocaproic acid (Amicar), which prevents the breakdown of blood clots and may be used to limit bleeding in the mouth during dental procedures

  • Birth control (oral contraceptive) pills, which may help control excessive menstrual bleeding in women with coagulopathy

  • Desmopressin acetate (DDVAP or Stimate), which may be used to release blood-clotting proteins stored in the body in cases of mild to moderate coagulopathy

  • Plasma-derived factor concentrates and recombinant factor concentrates, which replace missing clotting factors

What are the potential complications of coagulopathy?

Getting prompt treatment when bleeding begins is important to prevent or limit further injury or damage. Complications of untreated coagulopathy can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of coagulopathy include:

  • Anemia (low red blood cell count)

  • Deep internal bleeding

  • Joint deformity and destruction

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Bleeding disorders. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/bleedingdisorders.html
  2. Bleeding disorders. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001304.htm
  3. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.
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