Coagulopathy & the Bleeding Patient

Blood, Clots & Transfusion · ICU Decoded chapter 45 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to Massive transfusion protocols.

Key points

Coagulopathy patterns: low fibrinogen (early in DIC), low platelets (ooze), high aPTT (factor deficiency), high INR (liver/warfarin).
Run massive transfusion at 1:1:1, add tranexamic acid in trauma <3 h, and replace fibrinogen below 1.5 g/L (2 g/L in obstetric bleeding) with cryoprecipitate or concentrate.
Reverse specifically: warfarin (PCC+K), dabigatran (idarucizumab), Xa (4-factor PCC; andexanet withdrawn in the US), heparin (protamine).
DIC: treat the driver; support only for bleeding or procedures.

Investigations

First tests: Full blood count, PT/INR, aPTT and fibrinogen, Blood group and crossmatch, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: D-dimer / fibrin degradation products, Viscoelastic testing, Ionized calcium.

Repeat monitoring: Full blood count, PT/INR, aPTT and fibrinogen.

Locked

Treatment orders with doses
Why and when to send each test

Open the full chapter in ICU Decoded

Free with a referral from any ICU Decoded member, or by applying with your medical registration. How access works.

← Low Platelets: HIT, TTP, DIC · Transfusion: When & How Much →

More in Blood, Clots & Transfusion

Part of ICU Decoded — open the interactive version.

ICU Decoded — original critical-care and internal-medicine pathways by Dr Javed Akhtar, each cited to a current guideline. For education and quick reference; verify every dose against local protocols before prescribing.

Open the app · Ward Pathways — 87 cases · ICU Decoded chapters · Aladin Chirag bedside tools

How to use · About · Medical disclaimer · Privacy · Contact