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coagulopathy of liver disease

see cirrhosis & coagulopathy Laboratory: coagulopathy occurs when cirrhosis is advanced 1) prothrombin time (PT is generally prolonged as a result of dysfibrinogenemia 2) activated partial thromboplastin time (aPTT) is prolonged 3) thrombin time (TT) is prolonged 4) factor V in plasma is low, factor VII in plasma is low 5) factor VIII in plasma is high* (synthesized by vascular endothelium & cleared by liver) 6) D-dimer in plasma may be elevated (cleared by liver) * disinguishes from disseminated intravascular coagulation (DIC) Differential diagnosis: - disseminated intravascular coagulation (DIC) - factor VIII is consumed in DIC, thus factor VIII in plasma is low Management: - cryoprecipitate for hypofibrinogenemia [1] - maintain fibrinogen in plasma > 100 mg/dL [1] - platelet transfusions with target of platelets > 50,000/uL [1] - patients with mild coagulopathy (INR < 1.9) with marginal benefit from fresh frozen plasma or other transfusion prior to minor procedures, including central venous catheter insertion [1] - prothrombin complex concentrates should not be used routinely to due prothrombotic complications [1]

Related

cirrhosis

General

coagulation disorder; coagulopathy liver disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022.
  2. Tripodi A, Primignani M, Chantarangkul V et al An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology. 2009 Dec;137(6):2105-11 PMID: 19706293
  3. Mannucci PM, Tripodi A. Liver disease, coagulopathies and transfusion therapy. Blood Transfus. 2013 Jan;11(1):32-6 PMID: 23058863