Intensive Care Management of Liver Related Coagulation Disorders

Abstract

The liver plays a central role in hemostasis as it synthesizes nearly all circulating coagulation factors and inhibitors, as well as some of the components of the fibrinolytic system. The liver synthesizes thrombopoeitin, which is a hormone essential for stimulation of platelet production from megakaryocytes in the bone marrow. The liver diseases (whether acute or chronic) frequently are associated with complex alterations of the hemostatic system. The typical hemostatic profile of patients with advanced liver disease consists of decreased levels of nearly all proteins that promote or inhibit coagulation and fibrinolysis, thrombocytopenia, and platelet function defects.In contrast to most hemostatic proteins, levels of von Willebrand factor (VWF) are elevated due to enhanced production by the endothelium or reduced clearance by the liver. The reduced portal blood flow and blood vessel damage may play an important role in the increased risk of portal vein thrombosis (PVT), but the hemostatic status may also contribute because patients with cirrhosis carrying the prothrombin G20210A mutation appear to have an increased risk for of portal vein thrombosis. Therapy for hemostatic abnormalities of liver disease is needed only during variceal bleeding, surgery or before invasive procedures as Intravenous vitamin K injecton,Fresh frozen plasma, platelet transfusion, cryoprecipitate (containing factors VIII, fibrinogen, vWf, fibronectin and XIII), desmopressin and Recombinant activated factor VII (rFVIIa).