Here’s how readers responded to a You Make the Call question about bleeding prevention in a patient undergoing cervical spine surgery.
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Santosh Saraf, MD University of Illinois Health Chicago, IL
I do not see any need for any intervention. Proceed with surgery.
Ranga Brahmamdam, MD TriHealth Cancer Institute Cincinnati, OH
Kelty Baker, MD Houston Methodist Houston, TX
I would do a mixing study and anti-phospholipid antibody workup, as this could be a presentation of anti-PL syndrome and would make me consider thromboprophylaxis. If mixing corrects the PT, I would not treat but would observe carefully.
Roy Silverstein, MD Medical College of Wisconsin Milwaukee, WI
Due to a high-risk surgery on the C-spine, I would recommend administering fresh frozen plasma preoperatively in a loading dose of 15 to 20 mL/kg, followed by 5 mL/kg every 8 to 12 hours, for a few days until wounds heal.
Natalia Neparidze, MD Yale School of Medicine New Haven, CT
Panju Prithviraj, MD Port Clinton, OH
Imre Bodó, MD, PhD Winship Cancer Institute of Emory University Atlanta, GA
Michael H. Creer, MD Penn State Health Hershey, PA
Steven Sandler, MD Advocate Health Care Skokie, IL