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Editorials: POINT/COUNTERPOINT EDITORIALS |

Counterpoint: Should Coagulopathy Be Repaired Prior to Central Venous Line Insertion? NoNo Coagulopathy Repair Before Central Lines

Samuel Z. Goldhaber, MD, FCCP
Author and Funding Information

From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School.

Correspondence to: Samuel Z. Goldhaber, MD, FCCP, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: sgoldhaber@partners.org


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Goldhaber serves as a consultant for the following companies: Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eisai, Medscape, Merck, Portola, and Sanofi Aventis.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1142-1144. doi:10.1378/chest.11-3235
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Extract

The concept of “repairing a coagulopathy” is a comforting illusion. No one looks forward to inserting a central venous line in a frail patient with an activated partial thromboplastin time greater than assay or an international normalized ratio (INR) of 10 or 12. Our “gut reaction” is to “fix” any abnormal laboratory value prior to placing a central venous line. Therefore, at first glance, the “con” position is counterintuitive and goes against the grain of many established cultural practices and reflexive responses in the hospital setting. These traditions have evolved with the good intention of following two wise mottos: (1) “safety first,” and (2) “primum non nocere.” Nevertheless, upon closer inspection, it turns out that the “cure” of a laboratory-diagnosed coagulopathy is usually elusive. The coagulopathy is usually a manifestation of the underlying disease that required hospitalization. The attempt to “repair” a laboratory-diagnosed coagulopathy can do more harm than the laboratory abnormality itself. That is why I am taking the “con” position in this debate, even though I anticipate that explaining my position will require swimming against the tide.

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