Coagulopathy in Cirrhosis¶
Garren Montgomery, John Laurenzano
Background¶
- The liver is responsible for production of both pro- (factor II, V, VII, IV, X, and XI) and anti-coagulants (protein C, S) in hemostasis. Factor VIII is the only one not made by the liver.
- Thrombocytopenia is caused by splenic sequestration from portal HTN, failure to produce thrombopoietin (TPO), and bone marrow failure
Evaluation¶
-
INR/PT, and PTT are poorly reflective of bleeding risk
-
TEG screens and other measures of comprehensive coagulation in cirrhotics
Management¶
-
Even in bleeding, there is no need to intervene on an INR or platelet value
-
Pre-procedural FFP is not recommended, even in the presence of bleeding, but is frequently requested by different proceduralists
-
Low risk procedures (i.e., paracentesis) do not require pre-procedural blood products
-
In bleeding pts, the following are recommended per AASLD and AGA guidelines
- IV Vitamin K 10mg x 3 days
- FFP: Not recommended, unless as part of a balanced transfusion effort to avoid transfusion related coagulopathy, or if a TEG screen suggests potential benefit
- Cryoprecipitate: if fibrinogen < 120
- Platelets: No specific targets regardless of bleeding. Pre-procedurally, recommend >50
-
Appropriate DVT ppx should be given with few exceptions (plts <50k, active hemorrhage)
-
For TEG transfusion recommendations are as follows:
- 10 mg/kg FFP if R-time >10 minutes
- 1u Plts if maximum amplitude <55 mm
- 5u cryo if alpha angle <45
Last update:
2022-06-21 11:15:36