Liver disease induced coagulopathy

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Clinical Features

Differential Diagnosis


Platelet Related

Factor Related


  • 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


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)


See Also