Liver disease induced coagulopathy
Background
- 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
Treatment
Lab abnormalities only (w/o significant bleeding)
- Observation
Significant bleeding
- Vitamin K PO or IV
- Desmopressin
- Effective w/ minimal side effects
- 0.3 mg/kg IV (preferred) or SC (max 20mg)
- Onset of action ~1hr, duration of action ~4-24hr
- Cryoprecipitate
- May be used to replace fibrinogen in pts w/ fibrinogen levels <100
- 1 bag per 10kg of body weight
- Platlets
- 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/pepcid/octreotide (variceal bleed)
See Also
Source
- Tintinalli
- UpToDate