Liver disease induced coagulopathy
Revision as of 20:01, 22 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")
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
Evaluation
- 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
Management
Lab abnormalities only (with out significant bleeding)
- Observation
Significant bleeding
- Vitamin K PO or IV
- Desmopressin
- Effective with minimal side effects
- 0.3mg/kg IV (preferred) or SC (max 20mg)
- Onset of action ~1hr, duration of action ~4-24hr
- Cryoprecipitate
- May be used to replace fibrinogen in patients with 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)