Liver disease induced coagulopathy: Difference between revisions
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==Background== | ==Background== | ||
[[File:Liver vascular anatomy.png|thumb|Liver vascular anatomy.]] | |||
==Clinical Features== | ==Clinical Features== | ||
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{{Increased bleeding DDX}} | {{Increased bleeding DDX}} | ||
== | ==Evaluation== | ||
*PT prolongation | *PT prolongation | ||
**Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X) | **Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X) | ||
*Thrombocytopenia | *[[Thrombocytopenia]] | ||
**Portal hypertension | **Portal hypertension → congestive hypersplenism → splenic sequestration | ||
*Fibrinolysis increased | *Fibrinolysis increased | ||
**Due to decreased synthesis of alpha2 plasmin inhibitor | **Due to decreased synthesis of alpha2 plasmin inhibitor | ||
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==Management== | ==Management== | ||
===Lab abnormalities only ( | ===Lab abnormalities only (with out significant bleeding)=== | ||
*Observation | *Observation | ||
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*[[Vitamin K]] PO or IV | *[[Vitamin K]] PO or IV | ||
*[[Desmopressin]] | *[[Desmopressin]] | ||
**Effective | **Effective with minimal side effects | ||
**0. | **0.3mg/kg IV (preferred) or SC (max 20mg) | ||
**Onset of action ~1hr, duration of action ~4-24hr | **Onset of action ~1hr, duration of action ~4-24hr | ||
*[[Cryoprecipitate]] | *[[Cryoprecipitate]] | ||
**May be used to replace fibrinogen in patients | **May be used to replace fibrinogen in patients with fibrinogen levels <100 | ||
**1 bag per 10kg of body weight | **1 bag per 10kg of body weight | ||
*[[ | *[[Platelets]] | ||
**Aim for >50K for moderate risk procedures; >100K for high risk procedures | **Aim for >50K for moderate risk procedures; >100K for high risk procedures | ||
*[[FFP]] | *[[FFP]] | ||
**Use with caution; requires large volume of FFP to make a significant difference | **Use with caution; requires large volume of FFP to make a significant difference | ||
*PPI/ | *[[PPI]]/[[famotidine]]/[[octreotide]] ([[variceal bleeding]]) | ||
[[Category:GI]] | |||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Latest revision as of 23:03, 13 November 2024
Background
Clinical Features
Differential Diagnosis
Coagulopathy
Platelet Related
- Too few
- Nonfunctional
Factor Related
- Acquired (Drug Related)
- Warfarin (Coumadin)
- Unfractionated heparin
- Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
- Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
- Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
- Illness induced
- Genetic
Evaluation
- PT prolongation
- Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X)
- Thrombocytopenia
- Portal hypertension → congestive hypersplenism → splenic sequestration
- Fibrinolysis increased
- Due to decreased synthesis of alpha2 plasmin inhibitor
- Low fibrinogen level, mild elevation of FDP and D-dimer
Management
Lab abnormalities only (with out significant bleeding)
- Observation
Significant bleeding
- Vitamin K PO or IV
- Desmopressin
- Effective with minimal side effects
- 0.3mg/kg IV (preferred) or SC (max 20mg)
- Onset of action ~1hr, duration of action ~4-24hr
- Cryoprecipitate
- May be used to replace fibrinogen in patients with fibrinogen levels <100
- 1 bag per 10kg of body weight
- Platelets
- Aim for >50K for moderate risk procedures; >100K for high risk procedures
- FFP
- Use with caution; requires large volume of FFP to make a significant difference
- PPI/famotidine/octreotide (variceal bleeding)