• Sonja Škiljić, Nenad Nešković, Gordana Kristek, Marija Milić, Hrvoje Vinković, Karlo Kedačić, and Slavica Kvolik.
• Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia.
• Acta Clin Croat. 2023 Jul 1; 62 (Suppl2): 138142138-142.

AbstractCoagulation disorders in critically ill patients presenting with bleeding can be multicausal. The drugs applied can interfere and impair the coagulation cascade. Point-of-care (POC) coagulation assays may resolve difficult therapeutic situations in critical illness. We report on a 73-year-old critically ill male patient with massive hematuria after bladder lithotripsy. The patient was on low molecular weight heparin therapy due to recent pulmonary embolism. He was subjected to repeated surgical hemostasis which was ineffective despite massive transfusion protocol and normal standard coagulation profile. Additional POC coagulation assays were obtained and were indicative of platelet dysfunction. We revised his medical therapy and suspected the possible drug influence on platelet aggregation. After discontinuation of target drug, platelet aggregation increased whereas hematuria stopped. Coagulation disorders in intensive care unit patients are often multifactorial. Standard laboratory tests are unreliable in complex refractory bleeding and may result in inappropriate therapeutic decisions. Stepwise approach with assessment of clinical parameters, present therapy, and a combination of POC coagulation tests is the key to optimal therapeutic management.Sestre Milosrdnice University Hospital.

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