Liver disease induced coagulopathy

Background

Clinical Features

Differential Diagnosis

Coagulopathy

Platelet Related

Factor Related

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
  • 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)

Disposition

See Also

References