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I have a question regarding a patient:
Male patient, 54 years old, acute abdomen, massive internal bleeding (spontaneous retroperitoneal hematoma), under chronic anticoagulant treatment (coumarin overdose), severe coagulation deficiency.
The patient is undergoing haemodyalisis since 2004, three times a week. (kidney failure, stage 5)
What type of treatment should a surgeon choose:
a. start vitamin K treatment and wait for a better coagulation test result (INR)
b. immediate surgery intervention with presurgery and postsurgery vitamin K treatment
Your answers are both wrong, although additional data may be required( patients bp?)
If bp low and heart rate high and you have to operate you will give fresh frozen plasma, and maybe ddavp to correct the anticoagultion caused by the rena failure. This why you also have to check biochemical profile such as urea creatinine etc.
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