Clotting Abnormalities in Chronic Liver Disease

Violi, Francesco; Ferro, Domenico; Quintarelli, C.; Saliola, Mirella; Cordova, C; Balsano, F

doi:10.1159/000171354

Cited by 24 publications

(10 citation statements)

References 36 publications

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“…Dissociation of INR from liver function also occurs when conditions such as cholestasis, pancreatic insufficiency, or small intestinal disease cause vitamin K malabsorption, unless patients receive adequate parenteral vitamin K supplementation 16. In disseminated intravascular coagulation, prolongation of the INR reflects clotting factor consumption and anticoagulant effects of fibrin split products rather than synthetic liver function 17, 18. Conversely administration of fresh frozen plasma or factor VIIa to prevent or control hemorrhage transiently lowers the INR and may cause MELD to underestimate true disease severity 19.…”

Section: Discussionmentioning

confidence: 99%

MELD-XI: A rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy

et al. 2006

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Priority for "sickest first" liver transplantation (LT) in the United States is determined by the model for end-stage liver disease (MELD). MELD is a good predictor of short-term mortality in cirrhosis, but it can overestimate risk when international normalized ratio (INR) is artificially elevated by anticoagulation. An alternate prognostic index omitting INR is needed in this situation. We retrospectively analyzed survival data for 554 cirrhotic veterans referred for consideration of LT prior to December 1, 2003 (training group). Using logistic regression we derived a predictive formula for 90-day pretransplant mortality incorporating bilirubin and creatinine but omitting INR. We normalized this formula to the same scale as MELD using linear regression. This In conclusion, MELD-XI, despite omission of INR, is nearly as accurate as MELD in predicting short-term survival in cirrhosis. In patients treated with oral anticoagulants, substitution of MELD-XI for MELD may permit more accurate assessment of risk and more rational assignment of "sickest first" priority for LT. Liver Transpl 13:30-37, 2007.

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Section: Discussionmentioning

confidence: 99%

MELD-XI: A rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy

et al. 2006

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“…Correction of coagulopathy by intravenous vitamin K differentiates vitamin K deficiency from synthetic liver failure [49]. A degree of disseminated intravascular coagulopathy (DIC) invariably occurs in all patients with ALF and can progresses to fulminant DIC, when there is associated infection or bleeding.…”

Section: Coagulopathy In Liver Failurementioning

confidence: 99%

Neonatal liver failure: aetiologies and management—state of the art

et al. 2010

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Acute liver failure in neonates is rare, but carries a high mortality. Neonatal liver failure can be defined as "failure of the synthetic function of liver within 4 weeks of birth". Encephalopathy is not essential for the diagnosis. Acute liver failure in neonates differs from children with regard to aetiology and outcome. Common causes of neonatal liver failure are neonatal hemochromatosis, haematological malignancies, viral infections and liver-based metabolic defects. Early diagnosis and referral to a paediatric liver centre is recommended as liver transplantation is the only definitive treatment when supportive or a disease-specific treatment fails.

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“…For decades, chronic liver disease has been thought to be associated with an increased bleeding risk [1]. Hence, generally, physicians have taught and adopted a cautious approach to invasive procedures for fear of bleeding complications.…”

Section: Introductionmentioning

confidence: 99%