The definition of coagulopathy is “a condition in which the
blood’s ability to clot is impaired.” However, for some clinicians, the term
also covers thrombotic states, and because of the complexity of the hemostatic
pathways, the two conditions can exist simultaneously. Some practitioners
would consider that mildly abnormal results on coagulation screening without
bleeding can also indicate a coagulopathy. This review is confined to the original
definition of coagulopathy as given above. Such states are common in patients in
the intensive care unit (ICU) and require a clinicopathological approach to ensure
that the correct diagnosis is made and the appropriate treatment administered. The
lack of evidence for managing coagulopathies in critical care is striking. This review
will highlight selected areas in which there is high-quality evidence and at the
same time point out areas for which there is poor evidence. In the latter case, there
is little consensus on management.