title: Correction of subclinical coagulation disorders before percutaneous dilatational tracheotomy.
abstract: BACKGROUND
  There is evidence that percutaneous dilatational tracheotomy (PDT) can be safely performed in patients with severe coagulation disorders if these are carefully corrected immediately before the procedure. However, it is currently unclear whether PDT can be performed safely in patients in an Intensive Care Unit (ICU) with uncorrected mild coagulation disorders.
  
  
  METHODS
  In a randomised controlled trial we determined the effect of correction of mild coagulation disorders on bleeding during and after PDT. ICU patients planned for bedside PDT with: (i) a prothrombin time (PT) between 14.7-20.0 seconds, (ii) a platelet count between 40-100×10(9)/L and/or (iii) active treatment with acetylsalicylic acid were randomised to receive infusion with fresh-frozen plasma (FFP) and/or platelets ("correction") versus no transfusion ("no correction") before PDT.
  
  
  RESULTS
  We randomised 35 patients to the "correction" group and 37 patients to the "no correction" group. In patients who received FFP, the decrease in PT was marginal (mean decrease 0.40±0.56 seconds); the median increase in platelet counts after transfusion of platelets was 35 [11-47]x10(9)/L. The median blood loss was 3 [IQR: 1-6] grams in the "correction" group and 3 [IQR: 2-6] grams in the "no correction" group (P=0.96).
  
  
  CONCLUSIONS
  Bleeding during and after bedside PDT in ICU patients with mild coagulation disorders is rare in our setting. Correction of subclinical coagulation disorders by transfusion of FFP and/or platelets does not affect bleeding.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. d.p.veelo@amc.uva.nl
authors.forename: Denise P
authors.initials: DP
authors.lastname: Veelo
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Vlaar
authors.forename: Dave A
authors.initials: DA
authors.lastname: Dongelmans
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Marcel
authors.initials: M
authors.lastname: Levi
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.forename: Fenny
authors.initials: F
authors.lastname: Berends
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000628:therapy*; D001792:Blood Platelets / Q000166:cytology; D005260:Female; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000378:metabolism; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010976:Platelet Count; D017713:Platelet Transfusion; D011517:Prothrombin Time; D014140:Tracheotomy / Q000379:methods
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin