Contents -- Contributors -- Foreword -- Chapter 1 Pathophysiological Aspects of Coagulation Abdul Shlebak -- SECTION I: NORMAL HAEMOSTASIS -- A) Introduction -- Role of endothelium and subendothelium -- Role of platelets -- Platelet reactions and primary haemostatic plug formation -- Role of circulating proteins with procoagulant, anti-coagulant, and fibrinolytic activities -- Coagulation -- In vivo versus in vitro coagulation: The role of factor VII-tissue factor complex (TF-VII) -- The revised hypothesis of coagulation -- The role of vitamin K in blood coagulation -- Fibrinolysis -- B) Haemostatic regulation -- Natural anti-coagulants -- (1) Anti-thrombin: -- (2) Heparin co-factor II : -- (3) Protein C and Protein S pathway: -- C) Laboratory evaluation of haemostatic function -- Global tests of haemostatic function -- Blood count and blood film examination -- Screening tests of blood coagulation -- Specialised tests that may further delineate abnormal bleeding tendencies -- Assessing platelet function -- Specific assays for coagulation factors -- Tests for fibrinolysis -- SECTION II: VENOUS THROMBOEMBOLISM -- A) Introduction -- B) Risk factors in venous thromboembolism -- Acquired risk factors for venous thromboembolism -- Age -- Malignancy -- Anti-phospholipid antibodies -- History of venous thromboembolism -- Transient risk factors for venous thromboembolism -- Surgery and major trauma -- Pregnancy and the puerperium -- Oral contraceptives and hormone replacement therapy -- Prolonged immobilisation -- Inherited risk factors for venous thromboembolism -- Deficiencies of naturally occurring anti-coagulant proteins -- Factor V Leiden -- Prothrombin G20210A mutation -- Other risk factors for venous thromboembolism -- Hyperhomocysteinaemia -- High levels of factor VIII.

High levels of factor IX, factor XI, and thrombin activatable fibrinolysis inhibitor (TAFI) -- Activated protein C resistance (without factor V Leiden) -- Risk stratification in venous thromboembolism -- C) Haemostatic genetic risk factors in arterial thrombosis -- SECTION III: Thromoboprophylaxis for high-risk surgical patients -- Major orthopaedic surgery -- Non-pharmacological methods of prophylaxis -- Pharmacological prophylaxis -- Oncologic surgery -- D) Diagnosis of deep-vein thrombosis -- Introduction -- Diagnosis of first episode of DVT -- Clinical assessment -- Initial objective testing -- Compression venous ultrasonograph -- D-dimer testing -- Follow-up testing -- Pregnant women with suspected DVT -- DVT diagnosis algorithm -- Diagnosis of recurrent DVT -- Cost-effectiveness -- E) Treatment of acute DVT -- Initial anti-coagulant therapy -- Long-term anti-coagulant therapy -- Duration of anti-coagulant therapy -- PPS and its prevention -- Treatment of DVT in pregnancy -- Screening for thrombophilia -- New anti-thrombotic agents -- Thrombolytic therapy for DVT -- Vena caval interruption -- SECURING HAEMOSTASIS IN HAEMOSTATIC FAILURE -- General aspects of anti-coagulant therapy -- Heparin -- Laboratory monitoring -- Side effects -- Warfarin -- Laboratory monitoring -- Side effects -- Pregnancy -- Advantages of LMWH (Table 8) -- Disadvantages of LMWH -- cost -- Heparin-induced thrombocytopenia -- Accepted target INR therapeutic ranges -- Potential factors that interfere with anti-coagulant control -- Clinical conditions with potentiating effect on anti-coagulation -- Conditions with inhibitory effect on anti-coagulation -- Managing anti-coagulation in patients undergoing surgery -- Intermediate and major surgery (Fig. 13) -- (I) Low risk patients -- (II) High risk patients -- Reducing the risk of thromboembolism -- Preoperative.

Indications for warfarin -- (a) Arterial indications for anti-coagulation -- Previous ATE -- No previous ATE -- Last episode of ATE within 1 month -- (b) Venous indications for anti-coagulation -- Last VTE event within 1 month -- Last VTE between 1 to 3 months -- Last VTE >3 months -- Postoperative -- Previous ATE within 1 month of minor surgery -- Previous ATE within 1 month of major surgery -- No previous ATE within 1 month of surgery -- Postoperative VTE -- SURGERY IN PATIENTS WITH BLEEDING TENDENCY -- Inherited coagulation disorders -- von Willebrand's disease -- Haemophilia A (factor VIII deficiency) -- Haemophilia B (factor IX deficiency) (Christmas disease) -- Haemophilia and surgical procedures -- Intermediate and Major Procedures -- Plan of management -- Perioperative management -- Postoperative management -- Minor procedures -- HAEMOSTATIC ALTERATION IN CARDIOPULMONARY BYPASS SURGERY -- Determinants of haemostasis in CPB -- Perioperative bleeding -- MODIFYING PERIOPERATIVE BLOOD LOSS -- Pharmacological agents to reduce blood loss -- (1) Anti-fibrinolytics203--219 -- (2) Other anti-fibrinolytic agents -- (3) Fibrin sealants -- REFERENCES -- Chapter 2 Haemostasis in Neurosurgery Peter Bullock and Roopen Arya -- INTRODUCTION -- PREOPERATIVE ASSESSMENT -- INTRA-OPERATIVE TECHNIQUES -- INSTRUMENTATION FOR HAEMOSTASIS -- POSTOPERATIVE HAEMATOMA -- NON-SURGICAL MANAGEMENT OF PERIOPERATIVE BLEEDING IN NEUROSURGERY -- RISK OF THROMBOEMBOLISM IN NEUROSURGERY -- THROMBOPROPHYLAXIS IN ELECTIVE NEUROSURGERY -- TREATMENT OF VENOUS THROMBOEMBOLISM (VTE) IN NEUROSURGICAL PATIENTS -- REFERENCES -- Chapter 3 Haemostasis in Otorhinolaryngology and Head and Neck Surgery Julian A. Gaskin and Kalpesh S. Patel -- INTRODUCTION -- EAR -- NOSE -- HEAD AND NECK -- CONCLUSION -- REFERENCES.

Chapter 4 Haemostasis in Cardiac Surgery Shirish G. Ambekar and Brian Glenville -- HISTORICAL NOTE -- DYNAMICS OF COAGULATION, FIBRINOLYSIS, AND COMPLEMENT ACTIVATION -- CARDIOPULMONARY BYPASS (CPB) -- Role of Oxygenators in Haemostasis -- ANTI-COAGULATION DURING CARDIOPULMONARY BYPASS -- Heparin -- Protamine -- Role of Platelets in CPB and Anti-platelet Agents -- Thromboelastograph (TEG) -- Management of Postoperative Bleeding -- Vitamin K -- Sickle Cell Disease and Thalassemia in Cardiac Surgery -- Sickle cell haemoglobinopathy -- Thalassaemias -- Topical Agents -- Anti-fibrinolytic Agents -- Aprotinin -- ROLE OF RE-EXPLORATION -- Cardiac Tamponade -- The Role of Wound Packing -- Auto-transfusion, Cell-Savers, and Haemodilution in Cardiac Surgery -- SPECIFIC CHALLENGES IN CARDIAC SURGERY -- Surgery in Jehovah's Witnesses -- EMERGING TECHNOLOGIES -- REFERENCES -- Chapter 5 Haemostasis in Liver Surgery Madhava Pai, Ruben Canelo and Nagy Habib -- HISTORY -- ARGON BEAM COAGULATOR (ABC) -- LASER PHOTOCOAGULATION -- ULTRASONIC DISSECTOR -- ULTRASONICALLY ACTIVATED COAGULATING SCALPEL AND SHEARS -- WATER JET -- CAVITRON ULTRASONIC SURGICAL ASPIRATOR (CUSA) -- RADIO FREQUENCY (RF) ASSISTED LIVER RESECTION (HABIB'S TECHNIQUE) -- FLOATING BALL (TISSUE LINK) -- TOPICAL SEALANTS -- REFERENCES -- Chapter 6 Haemostasis in Liver Transplantation Surgery Raymond M. Planinsic and John J. Fung -- INTRODUCTION -- THE NORMAL HAEMOSTATIC MECHANISM -- MONITORING OF COAGULATION DURING OLT -- INTRA-OPERATIVE MANAGEMENT OF HAEMOSTASIS -- PREVENTION AND TREATMENT OF INTRA-OPERATIVE THROMBOSIS DURING OLT -- EFFECTS OF IMMUNOSUPPRESSANTS ON COAGULATION DURING OLT -- CONCLUSION -- REFERENCES -- Chapter 7 Haemostasis in Kidney and Pancreas Transplantations Muhammad Tariq Dosani and Nadey S. Hakim -- INTRODUCTION -- LIVE DONOR NEPHRECTOMY -- LAPAROSCOPIC DONOR NEPHRECTOMY.

CADAVERIC DONOR NEPHRECTOMY -- TRANSPLANT PROCEDURE -- BENCHWORK PREPARATION -- TRANSPLANT PROCEDURE -- HAEMOSTATIC TOOLS -- Vascular Closure Staples -- Chemical Haemostatic Agents (Surgicel) -- Use of Protamine -- VASCULAR COMPLICATIONS -- Renal Artery Thrombosis -- Renal Vein Thrombosis -- Lymphocele -- Renal Artery Stenosis -- Intrarenal Arteriovenous Fistulas and Pseudoaneurysms -- HAEMOSTASIS IN PANCREAS TRANSPLANTATION -- REFERENCES -- Chapter 8 Haemostasis in Endocrine Surgery Ian Maheswaran, Alberto Isla, John Lynn and Bill Fleming -- INTRODUCTION -- OPTIONS FOR HAEMOSTASIS IN ENDOCRINE SURGERY -- Mechanical Methods -- Sutures and ties -- Titanium clips -- Oxidised cellulose -- Electrical/Heat Methods -- Electrocautery -- Ultrasonic shears -- Ligasure -- Haemostatic Agents -- Fibrin sealant -- ENDOCRINE SURGICAL PROCEDURES -- Thyroid and Parathyroid Surgery -- Preoperative -- Intra-operative -- Postoperative -- Sternal split and mediastinal exploration -- Adrenal Surgery -- Adrenalectomy preparation -- Laparoscopic adrenalectomy -- Open adrenalectomy -- Pancreatic Endocrine Surgery -- Laparoscopic resection of insulinoma -- Open resection of endocrine tumours -- REFERENCES -- Chapter 9 Haemostasis in Urology Shabnam Undre and Anup Patel -- INTRODUCTION -- HAEMOSTASIS IN UROLOGY -- Renal Surgery -- Percutaneous renal surgery -- Renal trauma -- Nephrectomy -- Partial nephrectomy -- ESWL -- Renal transplant -- Adrenal Surgery -- Ureters -- Bladder -- Open surgery -- Endoscopic procedures -- Haematuria -- Prostate -- Trans-urethral procedures -- Open prostate surgery -- Testis, Epididymis, and Scrotum -- Penis and Male Urethra -- Miscellaneous Laparoscopic Surgery -- Paediatric Urology -- Circumcision -- REFERENCES -- Chapter 10 Haemostasis in Obstetrics and Gynaecology: Modern Management and Methods Deirdre Lyons -- VASCULAR INTEGRITY.

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