Coagulopathy: Pathophysiology, Evaluation, and Treatment

  • Bubu A. Banini
  • Arun J. Sanyal


Hemostasis consists of processes that promote coagulation and those that favor fibrinolysis. Both processes are essential to creating clot while localizing thrombosis to the site of injury and preventing uncontrolled thrombotic extension. In liver disease, changes occur in both anti- and pro-hemostatic mechanisms, leading to a rebalanced coagulation system. In cirrhosis, the rebalanced state can be disrupted by several factors including stasis, portal hypertension, dysfibrinogenemia, production of endogenous heparinoids, platelet and endothelial dysfunction, renal failure and infection. Whether planning an invasive procedure, major surgery or transplantation, there is much dilemma in how to properly treat these patients and their coagulopathic status. This chapter will explore the balance of hemostatic pathways, and review the defects that occur in progressive liver disease. We will also discuss how to evaluate and treat coagulopathy in this patient population, with...


Bleeding Rotational thrombelastogram Thrombelastography Clotting Hypercoaguability Thrombosis 





Central venous pressure




Epsilon-aminocaproic acid


Endothelial protein C receptor


Fresh frozen plasma


International normalized ratio


Plasminogen activator inhibitor


Prothrombin time


Partial thromboplastin time


Red blood cell


Transfusion associated circulatory overload


Thrombin activatable fibrinolysis factor




Tissue factor


Tissue factor pathway inhibitor




Tissue plasminogen activator


Transfusion related acute lung injury


Tranexamic acid


von Willebrand factor


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineVirginia Commonwealth UniversityRichmondUSA

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