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Review
. 2023 Dec 8;2023(1):274-280.
doi: 10.1182/hematology.2023000480.

How to manage hemostasis in patients with liver disease during interventions

Lara N Roberts  1
Affiliations
Review

How to manage hemostasis in patients with liver disease during interventions

Lara N Roberts. Hematology Am Soc Hematol Educ Program. .

Abstract

Patients with advanced chronic liver disease (CLD) often need procedures to both treat and prevent complications of portal hypertension such as ascites or gastrointestinal bleeding. Abnormal results for hemostatic tests, such as prolonged prothrombin time, international normalized ratio, and/or thrombocytopenia, are commonly encountered, raising concerns about increased bleeding risk and leading to transfusion to attempt to correct prior to interventions. However hemostatic markers are poor predictors of bleeding risk in CLD, and routine correction, particularly with fresh frozen plasma and routine platelet transfusions, should be avoided. This narrative review discusses the hemostatic management of patients with CLD using 2 case descriptions.

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Conflict of interest statement

Lara N. Roberts: no competing financial interests to declare.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Factors which modulate bleeding risk in patients with chronic liver disease in the periprocedural setting. ACLF, acute-on-chronic liver failure; AKI, acute kidney injury; CKD, chronic kidney disease; FFP, fresh frozen plasma.
Figure 2.
Figure 2.
Therapeutic doses of fresh frozen plasma (FFP) on international normalized ratio (INR) and endogenous thrombin potential (ETP). (A) INR and (B) ETP measured in the presence of thrombomodulin in 19 patients with chronic liver disease and a prolonged INR before and after FFP administration, compared with controls (n = 20). Bars represent median ± interquartile ranges. *P < .05. ****P < .0001, before vs after FFP transfusion. ##P < .01, patients vs controls. ####P < .0001, patients vs controls. Adapted from with permission from Elsevier Inc.
See this image and copyright information in PMC

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