coagulopathy of liver disease
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Introduction
see cirrhosis & coagulopathy
Laboratory
coagulopathy occurs when cirrhosis is advanced
- prothrombin time (PT is generally prolonged as a result of dysfibrinogenemia
- activated partial thromboplastin time (aPTT) is prolonged
- thrombin time (TT) is prolonged
- factor V in plasma is low, factor VII in plasma is low
- factor VIII in plasma is high* (synthesized by vascular endothelium & cleared by liver)
- D-dimer in plasma may be elevated (cleared by liver)
* disinguishes from disseminated intravascular coagulation (DIC)
Differential diagnosis
- disseminated intravascular coagulation (DIC)
- factor VIII is consumed in DIC, thus factor VIII in plasma is low
Management
- cryoprecipitate for hypofibrinogenemia[1]
- maintain fibrinogen in plasma > 100 mg/dL[1]
- platelet transfusions with target of platelets > 50,000/uL[1]
- patients with mild coagulopathy (INR < 1.9) with marginal benefit from fresh frozen plasma or other transfusion prior to minor procedures, including central venous catheter insertion[1]
- prothrombin complex concentrates should not be used routinely to due prothrombotic complications[1]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022.
- ↑ Tripodi A, Primignani M, Chantarangkul V et al An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology. 2009 Dec;137(6):2105-11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19706293
- ↑ Mannucci PM, Tripodi A. Liver disease, coagulopathies and transfusion therapy. Blood Transfus. 2013 Jan;11(1):32-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23058863