Liver disease induced coagulopathy: Difference between revisions
m (Rossdonaldson1 moved page Liver Disease Induced Coagulopathy to Liver disease induced coagulopathy) |
No edit summary |
||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
==Clinical Features== | |||
==Differential Diagnosis== | |||
{{Increased bleeding DDX}} | |||
==Diagnosis== | |||
*PT prolongation | *PT prolongation | ||
**Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X) | **Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X) | ||
Line 26: | Line 34: | ||
**Use with caution; requires large volume of FFP to make a significant difference | **Use with caution; requires large volume of FFP to make a significant difference | ||
*PPI/pepcid/octreotide (variceal bleed) | *PPI/pepcid/octreotide (variceal bleed) | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Coagulopathy (Main)]] | *[[Coagulopathy (Main)]] | ||
== | ==References== | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] |
Revision as of 12:47, 10 June 2015
Background
Clinical Features
Differential Diagnosis
Coagulopathy
Platelet Related
- Too few
- Nonfunctional
Factor Related
- Acquired (Drug Related)
- Warfarin (Coumadin)
- Unfractionated heparin
- Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
- Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
- Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
- Illness induced
- Genetic
Diagnosis
- 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
Lab abnormalities only (w/o significant bleeding)
- Observation
Significant bleeding
- Vitamin K PO or IV
- Desmopressin
- Effective w/ minimal side effects
- 0.3 mg/kg IV (preferred) or SC (max 20mg)
- Onset of action ~1hr, duration of action ~4-24hr
- Cryoprecipitate
- May be used to replace fibrinogen in pts w/ fibrinogen levels <100
- 1 bag per 10kg of body weight
- Platlets
- Aim for >50K for moderate risk procedures; >100K for high risk procedures
- FFP
- Use with caution; requires large volume of FFP to make a significant difference
- PPI/pepcid/octreotide (variceal bleed)