Coagulopathy of Liver Disease
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?
- Decreased synthesis of clotting factors
- Cholestasis leads to decreased vitamin K absorbtion, which leads to vitamin K deficiency
- 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.
- Fresh Frozen Plasma – Contains all of the clotting factors [Give if PT and PTT is prolonged or if bleed is present]
- Vitamin K in certain cases
- Platelet transfusions if thrombocytopenia is present
- Cryoprecipitate if there a deficiency of fibrinogen