How is coagulopathy treated in patients with acute liver failure?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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In the absence of bleeding, it is usually not necessary to correct clotting abnormalities with fresh frozen plasma (FFP). The exception is when an invasive procedure is planned or in the presence of profound coagulopathy (international normalized ratio [INR] >7). [43]

Prothrombin time (PT) and partial thromboplastin time (PTT) become prolonged when plasma coagulation components are diluted to less than 30%, and abnormal bleeding occurs when they are less than 17%. One unit of FFP increases the coagulation factor by 5%; 2 units increase it by 10%. An FFP infusion of 15 mL/kg of body weight or 4 units will correct the deficiency. If the fibrinogen level is very low (< 80 mg/dL), consider administering cryoprecipitate.

Recombinant factor VIIa may be used in patients whose condition is nonresponsive to FFP. It is used in a dose of 4 µg/kg intravenous (IV) push over 2-5 minutes. PT is normalized in 20 minutes and remains normalized for 3-4 hours.

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