Coagulopathy of Liver Disease

by / Tuesday, 22 June 2010 / Published in Internal Medicine


We know that all clotting factors are synthesized in the liver except vWF (von W. Factor), so when a liver disease becomes severe, a coagulopathy is likely to develop.….

Therefore, if a coagulopathy is due to liver failure, the overall prognosis for the patient is very poor.



Why does coagulopathy develop in the liver?

  1. Decreased synthesis of clotting factors
  2. Cholestasis leads to decreased vitamin K absorbtion, which leads to vitamin K deficiency
  3. Hypersplenism (due to portal vein hypertension) causes thrombocytopenia



  • Abnormal Bleeding – MC a GI bleed [Primarily due to varices, Secondarily due to portal HTN]
  • Prolonged PT & PTT (especially PT)

*** Prolonged PT is a poor prognostic indicator in cirrhosis because synthesis of clotting factors is NOT significantly impaired until liver disease is advanced.


  1. Fresh Frozen Plasma – Contains all of the clotting factors [Give if PT and PTT is prolonged or if bleed is present]
  2. Vitamin K in certain cases
  3. Platelet transfusions if thrombocytopenia is present
  4. Cryoprecipitate if there a deficiency of fibrinogen

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