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| ==[[Liver Disease Induced Coagulopathy]]== | | ==[[Liver Disease Induced Coagulopathy]]== |
| ===Background===
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| *PT prolongation
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| **Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X)
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| *Thrombocytopenia
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| **Portal hypertension -> congestive hypersplenism -> splenic sequestration
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| *Fibrinolysis increased
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| **Due to decreased synthesis of alpha2 plasmin inhibitor
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| **Low fibrinogen level, mild elevation of FDP and D-dimer
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| ===Treatment===
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| #Lab abnormalities only (w/o significant bleeding)
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| ##Observation
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| #Significant bleeding
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| ##Vitamin K PO or IV
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| ##Desmopressin
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| ###Effective w/ minimal side effects
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| ###0.3 mg/kg IV (preferred) or SC (max 20mg)
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| ###Onset of action ~1hr, duration of action ~4-24hr
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| ##Cryoprecipitate
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| ###May be used to replace fibrinogen in pts w/ fibrinogen levels <100
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| ###1 bag per 10kg of body weight
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| ##Plts
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| ###Aim for >50K for moderate risk procedures; >100K for high risk procedures
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| ##FFP
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| ###Use w/ caution; requires large volume of FFP to make a significant difference
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| ##PPI/pepcid/octreotide (variceal bleed)
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| ==[[Renal Disease Induced Coagulopathy]]== | | ==[[Renal Disease Induced Coagulopathy]]== |
