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| | ==[[Liver Disease Induced Coagulopathy]]== | | ==[[Liver Disease Induced Coagulopathy]]== |
| − | ===Background===
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| − | *PT prolongation
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| − | **Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X)
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| − | *Thrombocytopenia
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| − | **Portal hypertension -> congestive hypersplenism -> splenic sequestration
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| − | *Fibrinolysis increased
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| − | **Due to decreased synthesis of alpha2 plasmin inhibitor
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| − | **Low fibrinogen level, mild elevation of FDP and D-dimer
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| − |
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| − | ===Treatment===
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| − | #Lab abnormalities only (w/o significant bleeding)
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| − | ##Observation
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| − | #Significant bleeding
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| − | ##Vitamin K PO or IV
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| − | ##Desmopressin
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| − | ###Effective w/ minimal side effects
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| − | ###0.3 mg/kg IV (preferred) or SC (max 20mg)
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| − | ###Onset of action ~1hr, duration of action ~4-24hr
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| − | ##Cryoprecipitate
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| − | ###May be used to replace fibrinogen in pts w/ fibrinogen levels <100
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| − | ###1 bag per 10kg of body weight
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| − | ##Plts
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| − | ###Aim for >50K for moderate risk procedures; >100K for high risk procedures
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| − | ##FFP
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| − | ###Use w/ caution; requires large volume of FFP to make a significant difference
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| − | ##PPI/pepcid/octreotide (variceal bleed)
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| | ==[[Renal Disease Induced Coagulopathy]]== | | ==[[Renal Disease Induced Coagulopathy]]== |
