Grateful to @DougSimonetto from @MayoClinicGIHep for talking to @UMN_GI about the recent the @AmCollegeGastro guidelines on Disorders of Hepatic and Mesenteric Circulation (as a part of our @AASLDtweets ELS project!)
pubmed.ncbi.nlm.nih.gov/31895720/
pubmed.ncbi.nlm.nih.gov/31895720/
⭐️ Coagulopthy of liver disease is a delicate balance ⚖️
☑️INR is 🚫 a useful marker to asses clotting & bleeding risk
☑️ For high risk procedures, consider TPO agonist if plt < 50k & not emergent (takes 5-7 days). beware in history of PVT
☑️Consider viscoelastic tests
☑️INR is 🚫 a useful marker to asses clotting & bleeding risk
☑️ For high risk procedures, consider TPO agonist if plt < 50k & not emergent (takes 5-7 days). beware in history of PVT
☑️Consider viscoelastic tests
⭐️Portal Vein Thrombosis
☑️Consider thrombophilia workup in certain pts w/cirrhosis, such as CTP A
☑️For chronic PVT, consider anti-coag if bowel ischemia, thrombus progression, MV extension & TP
☑️For DOAC: 🚫 use in CTP C. Beware of DILI. Affected by bowel edema in portal HTN
☑️Consider thrombophilia workup in certain pts w/cirrhosis, such as CTP A
☑️For chronic PVT, consider anti-coag if bowel ischemia, thrombus progression, MV extension & TP
☑️For DOAC: 🚫 use in CTP C. Beware of DILI. Affected by bowel edema in portal HTN
⭐️Budd-Chiari
☑️Make sure to complete the FULL work up for etiologies
☑️For patients who fail anti-coagulation, consider angioplasty for short segment
☑️Treatment failure: consider TIPS/DIPS
☑️Make sure to complete the FULL work up for etiologies
☑️For patients who fail anti-coagulation, consider angioplasty for short segment
☑️Treatment failure: consider TIPS/DIPS
