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Coagulopathy in Cirrhotic Patients: Evaluation and Management

  • Richard Smith
Chapter

Abstract

Cirrhotic patients pose a challenge to surgeons based on liver dysfunction leading to increased complications and mortality. This is often believed to be a result of a coagulopathy leading to excessive bleeding. However, under general conditions, the patient with liver cirrhosis is in hemostatic balance and at risk for both bleeding and thrombotic events. Standard laboratory evaluations (platelet count, PT, and APTT) are poor predictors of bleeding risk. Correction based on these laboratory values may actually exacerbate bleeding by increasing portal pressures with volume overload. The strategy for preventing bleeding should be keeping CVP and total circulating volume low intraoperatively and modifying known risk factors for bleeding in patients with cirrhosis such as infection and renal failure. Ideally procedures should be undertaken in facilities with experience in dealing with patients with cirrhosis such as transplant centers where physicians from all disciplines dealing with liver disease can provide a comprehensive treatment plan. Although it is clear that prophylactic correction of abnormal hemostatic parameters should be abandoned, specific data to support treatment schemes based on this new approach are scarce. Further research is needed to accurately predict bleeding risk in patients with liver disease.

Keywords

Cirrhosis Rebalanced hemostasis Thromboelastography Thromboelastometry Liver transplantation Thrombocytopenia Portal hypertension 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Richard Smith
    • 1
  1. 1.Department of SurgeryUniversity of MissouriColumbiaUSA

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