Perioperative Bleeding - Liver Disease

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Abnormal liver function, as a result of acute or chronic liver disease, is associated with coagulation abnormalities 9 because many coagulation factors are produced in the liver. 10

Table 1. Coagulation defects in liver disease. 10 
• Decreased synthesis of coagulation factors (except factor VIII and VWF)
• Hypofibrinogenemia (endstage liver failure)
• Vitamin K deficiency (factors II, VII, IX, X)
• Decreased clearance of degraded coagulation factors
• Decreased synthesis of natural anticoagulant proteins
• Decreased clearance of activated coagulation factors
• Synthesis of abnormal fibrinogen
• Increased levels of circulating tissue plasminogen activator (tPA) activity due to impaired hepatic clearance
• Decreased synthesis of fibrinolytic inhibitors
• Decreased thrombin-activatable fibrinolytic inhibitor (TAFI)
CSL Behring products used in the treatment of coagulopathy in liver disease include:
  • Beriplex® P/N, Confidex®

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