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Treatment of Coagulopathy Related to Hepatic Insufficiency

Barton, Cassie A. PharmD, BCPS, BCCCP

doi: 10.1097/CCM.0000000000001998
Concise Definitive Review

Objectives: To provide a concise review of the medical management of coagulopathy related to hepatic insufficiency. This review will focus on prevention and management of bleeding episodes in patients with hepatic insufficiency. The treatment and prevention of thromboembolic complications will also be addressed.

Data Sources: Electronic search of PubMed database using relevant search terms, including hepatic coagulopathy, hemorrhage, liver diseases, blood coagulation disorders, blood transfusion, disseminated intravascular coagulation, and liver failure. Subsequent searches were done on specific issues.

Study Selection: Articles considered include original articles, review articles, guidelines, consensus statements, and conference proceedings.

Data Extraction: A detailed review of scientific, peer-reviewed data was performed. Relevant publications were included and summarized.

Data Synthesis: Available evidence is used to describe and summarize currently available tests of hemostasis, utilization of prohemostatic agents, transfusion strategies, use of prophylactic anticoagulation and treatment of thromboembolic events in patients with hepatic insufficiency.

Conclusions: Dynamic changes to hemostasis occur in patients with hepatic insufficiency. Routine laboratory tests of hemostasis are unable to reflect these changes and should not be used exclusively to evaluate coagulopathy. Newer testing methods are available to provide data on the entire spectrum of clotting but are not validated in acute bleeding. Prohemostatic agents utilized to prevent bleeding should only be considered when the risk of bleeding outweighs the risk of thrombotic complications. Restrictive transfusion strategies may avoid exacerbation of acute bleeding. Prophylaxis against and treatment of thromboembolic events are necessary and should consider patient specific factors.

Department of Pharmacy, Oregon Health & Science University, Portland, OR

Dr. Barton disclosed off-label product use (the use of recombinant factor VIIa, prothrombin complex concentrates, desmopressin, eltrombopag, and tranexamic acid are all off-label uses for indications discussed in this article).

For information regarding this article, E-mail: bartonc@ohsu.edu

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