Assessment and management of coagulopathy in critically-ill patients with liver failure

Fuat H. Saner, Dmitri Bezinover

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

PURPOSE OF REVIEW: This review provides insight into our current understanding of the pathophysiology and treatment of coagulopathy associated with liver failure, and bleeding risk assessment. RECENT FINDINGS: Patients with end-stage liver disease (ESLD) have a rebalanced coagulation profile and are at risk for both excessive clotting and bleeding. Hypercoagulability is associated with profound endothelial dysfunction and an increased concentration of liver-independent coagulation factors. Because of this rebalanced coagulation profile, standard laboratory tests have been demonstrated to be ineffective in either predicting and/or guiding the management of coagulopathy. Viscoelastic testing, however, is able to provide a dynamic assessment of clot formation in whole blood and has been demonstrated to be invaluable in both monitoring and management of coagulation problems associated with liver failure. More recently, there is increasing interest in thrombin generation tests to monitor coagulation in patients with ESLD.Multiple institutional protocols for prophylaxis and treatment of ESLD-related thromboses have been developed. High-quality studies evaluating these approaches are lacking. SUMMARY: Patients with ESLD are at risk for excessive bleeding and clotting. Treatment of any significant coagulopathy should not be based solely on standard laboratory tests. Thrombosis prophylaxis has to be considered in susceptible populations.

Original languageEnglish (US)
Pages (from-to)179-186
Number of pages8
JournalCurrent opinion in critical care
Volume25
Issue number2
DOIs
StatePublished - Apr 1 2019

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End Stage Liver Disease
Liver Failure
Critical Illness
Hemorrhage
Thrombosis
Blood Coagulation Factors
Thrombophilia
Clinical Protocols
Thrombin
Liver
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

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Assessment and management of coagulopathy in critically-ill patients with liver failure. / Saner, Fuat H.; Bezinover, Dmitri.

In: Current opinion in critical care, Vol. 25, No. 2, 01.04.2019, p. 179-186.

Research output: Contribution to journalArticle

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