Coagulopathy of Liver Disease

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

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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.

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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

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CLINICAL FEATURES:

  • 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.

TREATMENT/MANAGEMENT:

  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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