🩸 Hemostasis in Cirrhosis ≠ Coagulopathy 🩸🧵

Traditional indicators of hemostasis
🩸PT
🩸INR
🩸aPTT

Let’s talk about why these labs don’t actually predict bleeding risk in cirrhosis
🔗
#LiverTwitter #MedEd #GIdoi.org/10.1097/HEP.00… Cirrhosis is marked by hepatic synthetic function decline

It affects both:
✅Procoagulant (e.g., factors II, VII, IX, X) and
❌Anticoagulant factors (e.g., protein C, protein S, antithrombin).

The result isn’t “auto-anticoagulation” — it’s a rebalanced hemostatic state.

Hepatocellular Carcinoma (HCC): a 🧵

Inspired by the recently developed @AASLDtweets guidance, available in preprint format (most images take from preprint)

🔗DOI.org/10.1097/HEP.00… Screen in high risk patients (see picture) q6 mo using:
✅ RUQ U/S
✅ AFP
⚠️ AASLD does NOT recommend routine use of CT/MRI for screening

Stop screening if:
🛑 CPT C cirrhosis not eligible for transplant
🛑 Life limiting comorbidities

What are the liver function tests (LFTs)?

LFTs also called hepatic function panel (HFP) is an order in medicine that gives you a number of serological values related to the liver, namely:

🔹 Total bilirubin
🔹 Total protein
🔹 Albumin
🔹 ALT
🔹 AST
🔹 Alkaline phosphatase (ALP) In medicine, we frequently say a patient has elevated LFTs, meaning that the values of these labs are elevated and something is wrong with the liver!

Classically, the “LFTs” that are elevated are varying degrees of:
🔴 Total bilirubin (Tbili)
🔴 ALT
🔴 AST
🔴 ALP