1/ #tweetorial
💠 Anticipate Bleeding and Reverse Coagulopathies in Liver Failure - Key Points
➡️ Blood clotting in the setting of chronic liver disease is complex and may result in a net prothrombotic or antithrombotic state.
manualofmedicine.com/topics/gastroe…
#foamed #medtwitter
💠 Anticipate Bleeding and Reverse Coagulopathies in Liver Failure - Key Points
➡️ Blood clotting in the setting of chronic liver disease is complex and may result in a net prothrombotic or antithrombotic state.
manualofmedicine.com/topics/gastroe…
#foamed #medtwitter
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➡️ Favoring bleeding (antithrombotic state) are:
👉 reductions in hepatically produced procoagulant factors (II, VII, IX, and X) and fibrinogen.
👉 thrombocytopenia due to reduced thrombopoietin production, splenic sequestration, and production of antiplatelet antibodies.
➡️ Favoring bleeding (antithrombotic state) are:
👉 reductions in hepatically produced procoagulant factors (II, VII, IX, and X) and fibrinogen.
👉 thrombocytopenia due to reduced thrombopoietin production, splenic sequestration, and production of antiplatelet antibodies.
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➡️ Favoring thromboses (prothrombotic state) are:
👉 reductions in a strong anticoagulant factor (protein C).
👉 increased platelet activation due to elevated von Willebrand factor levels.
➡️ Favoring thromboses (prothrombotic state) are:
👉 reductions in a strong anticoagulant factor (protein C).
👉 increased platelet activation due to elevated von Willebrand factor levels.
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➡️ Any patient with liver failure either actively bleeding or at risk of bleeding should have the following tests sent:
👉 prothrombin time/INR
👉 fibrinogen level
👉 platelet count
➡️ Any patient with liver failure either actively bleeding or at risk of bleeding should have the following tests sent:
👉 prothrombin time/INR
👉 fibrinogen level
👉 platelet count
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➡️ Patients with liver failure generally compensate for coagulopathy, and corrective medications or blood products should not be administered to patients without an active or anticipated source of bleeding, such as planned invasive procedures.
➡️ Patients with liver failure generally compensate for coagulopathy, and corrective medications or blood products should not be administered to patients without an active or anticipated source of bleeding, such as planned invasive procedures.
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➡️ Procedures with a high risk of harmful bleeding include:
👉 central lines
👉 lumbar punctures
👉 intracranial monitor placement
➡️ Procedures with a high risk of harmful bleeding include:
👉 central lines
👉 lumbar punctures
👉 intracranial monitor placement
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➡️ If the fibrinogen level is under 100 mg/dL and the patient warrants correction, cryoprecipitate should be given.
➡️ If the platelet count is <50 × 10^9/L during active or anticipated bleeding, 1 unit of platelets should be administered.
➡️ If the fibrinogen level is under 100 mg/dL and the patient warrants correction, cryoprecipitate should be given.
➡️ If the platelet count is <50 × 10^9/L during active or anticipated bleeding, 1 unit of platelets should be administered.
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➡️ Certain very high-risk procedures, such as ICP monitor placement, may warrant a higher platelet goal of >100 × 10^9/L.
➡️ For patients without active or anticipated bleeding, platelet transfusion should be considered only for a platelet count of <10 × 10^9/L
➡️ Certain very high-risk procedures, such as ICP monitor placement, may warrant a higher platelet goal of >100 × 10^9/L.
➡️ For patients without active or anticipated bleeding, platelet transfusion should be considered only for a platelet count of <10 × 10^9/L
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➡️ Fresh frozen plasma (FFP) is the frontline therapy for active or anticipated bleeding with INR over 2.0
➡️ The large volume of FFP required to treat coagulopathy may cause volume overload, which can worsen portal hypertension and bleeding due to gastroesophageal varices.
➡️ Fresh frozen plasma (FFP) is the frontline therapy for active or anticipated bleeding with INR over 2.0
➡️ The large volume of FFP required to treat coagulopathy may cause volume overload, which can worsen portal hypertension and bleeding due to gastroesophageal varices.
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