Clinical Considerations of Coagulopathy in Acute Liver Failure

Kim, Ah Young; Niu, Bolin; Woreta, Tinsay A.; Chen, Po Hung

doi:10.14218/jcth.2020.00058

Cited by 12 publications

(6 citation statements)

References 51 publications

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“…The exact mechanism of coagulopathy in ALF is complex and remains incompletely understood; multiple factors contribute to changes of hemostasis in ALF (66). Despite the frequently extreme elevation of the INR and the prognostic significance of prolonged prothrombin time, INR is not an accurate predictor of bleeding risk in ALF (67).…”

Section: System-specific Managementmentioning

confidence: 99%

Acute Liver Failure Guidelines

et al. 2023

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Acute liver failure (ALF) is a rare, acute, potentially reversible condition resulting in severe liver impairment and rapid clinical deterioration in patients without preexisting liver disease. Due to the rarity of this condition, published studies are limited by the use of retrospective or prospective cohorts and lack of randomized controlled trials. Current guidelines represent the suggested approach to the identification, treatment, and management of ALF and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence was reviewed using the Grading of Recommendations, Assessment, Development and Evaluation process to develop recommendations. When no robust evidence was available, expert opinions were summarized using Key Concepts. Considering the variety of clinical presentations of ALF, individualization of care should be applied in specific clinical scenarios.

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Section: System-specific Managementmentioning

confidence: 99%

Acute Liver Failure Guidelines

et al. 2023

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“…Even though there are many similarities in the haemostatic changes that occur in acute and chronic liver disease, there are some distinct features that characterize each. For example, in acute liver failure thrombocytopaenia is typically milder than in chronic liver disease, whereas plasma levels of coagulation factors are usually lower in acute liver failure 5 . In chronic liver disease, haemostatic profiles appear similar among various aetiologies, 6 although the cholestatic liver disease has also been associated with a more hypercoagulable profile compared to other aetiologies 7 …”

Section: Haemostatic Changes In Liver Diseasementioning

confidence: 99%

“…For example, in acute liver failure thrombocytopaenia is typically milder than in chronic liver disease, whereas plasma levels of coagulation factors are usually lower in acute liver failure. 5 In chronic liver disease, haemostatic profiles appear similar among…”

Section: Haemostatic Changes In Liver Diseasementioning

confidence: 99%

Pathophysiology and management of bleeding and thrombosis in patients with liver disease

Boom

Lisman

2022

Int J Lab Hematology

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Patients with liver disease often develop complex changes in their haemostatic system. Frequently observed changes include thrombocytopaenia and altered plasma levels of most of the proteins involved in haemostasis. Although liver disease was historically classified as a haemostasis-related bleeding disorder, it has now been well established that the antihaemostatic changes that promote bleeding are compensated for by prohaemostatic changes. Conventional coagulation tests however do not accurately reflect these prohaemostatic changes, resulting in an underestimation of haemostatic potential. Novel coagulation tests, such as viscoelastic tests (VETs) and thrombin generation assays (TGAs) better reflect the net result of the haemostatic changes in patients with liver disease, and demonstrate a new, "rebalanced" haemostatic status. Although rebalanced, this haemostatic status is more fragile than in patients without liver disease. Patients with liver disease are therefore not only at risk of bleeding but also at risk of thrombosis. Notably, however, many haemostatic complications in liver disease are not related to the haemostatic failure. It is, therefore, crucial to identify the cause of the bleed or thrombotic complication in order to provide adequate treatment. In this paper, we will elaborate on the haemostatic changes that occur in liver disease, reflect on laboratory and clinical studies over the last few years, and explore the pathophysiologies of bleeding and thrombosis in this specific patient group.

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“…In addition, pathological findings do not translate into bleeding risk or the need for coagulation factors [74][75][76]. Viscoelastic tests may be superior in evaluating clot formation ability in patients with liver disease [77,78]. Coagulation therapy should be considered for patients at high risk of bleeding, with a scheduled invasive procedure or for patients actively bleeding [79,80].…”

Section: Liver Diseasementioning

confidence: 99%

Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding

Neuenfeldt

Weigand

Fischer

2021

JCM

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Patient Blood Management advocates an individualized treatment approach, tailored to each patient’s needs, in order to reduce unnecessary exposure to allogeneic blood products. The optimization of hemostasis and minimization of blood loss is of high importance when it comes to critical care patients, as coagulopathies are a common phenomenon among them and may significantly impact morbidity and mortality. Treating coagulopathies is complex as thrombotic and hemorrhagic conditions may coexist and the medications at hand to modulate hemostasis can be powerful. The cornerstones of coagulation management are an appropriate patient evaluation, including the individual risk of bleeding weighed against the risk of thrombosis, a proper diagnostic work-up of the coagulopathy’s etiology, treatment with targeted therapies, and transfusion of blood product components when clinically indicated in a goal-directed manner. In this article, we will outline various reasons for coagulopathy in critical care patients to highlight the aspects that need special consideration. The treatment options outlined in this article include anticoagulation, anticoagulant reversal, clotting factor concentrates, antifibrinolytic agents, desmopressin, fresh frozen plasma, and platelets. This article outlines concepts with the aim of the minimization of complications associated with coagulopathies in critically ill patients. Hereditary coagulopathies will be omitted in this review.

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Clinical Considerations of Coagulopathy in Acute Liver Failure

Cited by 12 publications

References 51 publications

Acute Liver Failure Guidelines

Acute Liver Failure Guidelines

Pathophysiology and management of bleeding and thrombosis in patients with liver disease

Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding

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