Managing Coagulation Abnormalities in Patients with Cirrhosis

Liver-related acquired coagulation disorders in patients with cirrhosis are poorly understood. Growing evidence suggests that these patients maintain a tenuous balancing act between procoagulant and anticoagulant activity. For example, patients with cirrhosis who have low platelet counts and elevated international normalized ratios can spontaneously develop portal-vein thrombosis (PVT). This complex hemostatic state makes it a challenge to manage gastrointestinal bleeding and venous thrombosis.

Now, investigators have reviewed the essential and practical aspects of coagulation in liver disease for the practicing clinician. Recommendations for managing hemostasis in patients with liver disease include the following:

• For bleeding esophageal var…