Liver disease induced coagulopathy: Difference between revisions

Revision as of 17:51, 1 May 2015

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

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)

Authors:

@@ Line 9: / Line 9: @@
 ==Treatment==
-#Lab abnormalities only (w/o significant bleeding)
+===Lab abnormalities only (w/o significant bleeding)===
-##Observation
+*Observation
-#Significant bleeding
-##Vitamin K PO or IV
+===Significant bleeding===
-##Desmopressin
+*[[Vitamin K]] PO or IV
-###Effective w/ minimal side effects
+*[[Desmopressin]]
-###0.3 mg/kg IV (preferred) or SC (max 20mg)
+**Effective w/ minimal side effects
-###Onset of action ~1hr, duration of action ~4-24hr
+**0.3 mg/kg IV (preferred) or SC (max 20mg)
-##Cryoprecipitate
+**Onset of action ~1hr, duration of action ~4-24hr
-###May be used to replace fibrinogen in pts w/ fibrinogen levels <100
+*[[Cryoprecipitate]]
-###1 bag per 10kg of body weight
+**May be used to replace fibrinogen in pts w/ fibrinogen levels <100
-##Plts
+**1 bag per 10kg of body weight
-###Aim for >50K for moderate risk procedures; >100K for high risk procedures
+*[[Platlets]]
-##FFP
+**Aim for >50K for moderate risk procedures; >100K for high risk procedures
-###Use w/ caution; requires large volume of FFP to make a significant difference
+*[[FFP]]
-##PPI/pepcid/octreotide (variceal bleed)
+**Use with caution; requires large volume of FFP to make a significant difference
+*PPI/pepcid/octreotide (variceal bleed)
 ==See Also==