Review Article
Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis
Table 1
Therapeutic options in coagulopathy in decompensated liver cirrhosis.
| Agent | Utility in specific situations | Comment |
| Red blood cell transfusion | Bleeding patients | Transfusion should be minimum, not allowing Hb to exceed 8 to 9 mg% | Vitamin K | Every patient | May not be useful if patient has no deficiency | Fresh frozen plasma | Questionable in bleeding patients | May be used in bleeding patients when volume expansion is not a concern | Platelets | Count less than 50.000 | Limited data | Cryoprecipitate | In bleeding patients | Limited data | Prothrombin complex concentrate | In bleeding patients | Limited data | Desmopressin | In bleeding patients | Efficacy unproved | Aprotinin, transexamine acid, and epsilon amino caprioric acid | Patients with hypofibrinogenemia Fibrinogen less than 100/dL | Can induce thrombosis | Recombinant factor VII | In placing ICP devices, bleeding after surgery, massive variceal bleed | Can induce thrombosis | Topical agents—cyanoacrylates, fibrin glue, and thrombin | Topical heamostasis and localized bleeding | Extremely expensive and limited data | Reduction in the portal pressure, maintaining low CVP by volume contraction (phlebotomy/diuresis) | | | Surgical techniques—vascular clamping, ultrasonic/hydrojet dissectors, and thermal techniques (aarton plasma coagulator, radio frequency ablators) | | |
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