Liver disease induced coagulopathy

Background

• 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

Treatment

1. Lab abnormalities only (w/o significant bleeding)
   1. Observation
2. Significant bleeding
   1. Vitamin K PO or IV
   2. Desmopressin
      1. Effective w/ minimal side effects
      2. 0.3 mg/kg IV (preferred) or SC (max 20mg)
      3. Onset of action ~1hr, duration of action ~4-24hr
   3. Cryoprecipitate
      1. May be used to replace fibrinogen in pts w/ fibrinogen levels <100
      2. 1 bag per 10kg of body weight
   4. Plts
      1. Aim for >50K for moderate risk procedures; >100K for high risk procedures
   5. FFP
      1. Use w/ caution; requires large volume of FFP to make a significant difference
   6. PPI/pepcid/octreotide (variceal bleed)

See Also

• Coagulopathy (Main)

Source

• Tintinalli
• UpToDate