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)