Correction of Abnormal Coagulation in Chronic Liver Disease by Combined Use of Fresh-Frozen Plasma and Prothrombin Complex Concentrates

Mannucci, Pier Mannuccio; Franchi, Franca; Dioguardi, N

doi:10.1016/s0140-6736(76)91794-3

Cited by 90 publications

(50 citation statements)

References 11 publications

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“…In patients with chronic liver disease a hemostatic impairment is extremely common and contributes to bleeding [1], Usually pro phylaxis and treatment of bleeding in patients with liver cirrhosis requires plasma deriva tives, such as fresh frozen plasma, prothrom bin complex concentrates or, more recently, antithrombin III concentrates [2,3]. Plasma derivatives carry the risk of viral disease transmission and of thromboembolic side ef fects [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Vitamin K, fresh frozen plasma, prothrom bin complex concentrates, antithrombin III concentrates and supportive measures are used in the prevention and treatment of bleeding complications in patients with liver cirrhosis [2,3], Vitamin K is only partially effective and, moreover, requires hours to show its beneficial effects. Blood-derived products are expensive and carry the risk of viral transmission [4], In addition, prothrom bin complex concentrates have been reported to potentially trigger disseminated intravascu lar coagulation and cause thromboembolic complications [5].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Desmopressin on Hemostasis in Patients with Liver Cirrhosis

Agnelli

Parise²,

Levi³

et al. 1995

Pathophysiol Haemos Thromb

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The aim of this double-blind, placebo-controlled crossover study was to investigate the effect of 1-deamino-8-D-arginine vasopressin (dDAVP) on hemostasis in patients with chronic liver disease. Nine consecutive patients with biopsy-proven liver cirrhosis and related coagulation abnormalities received in a random order dDAVP, 0.5 μg/kg, or saline intravenously. Blood samples were taken before dDAVP infusion and 30, 60 and 180 min after its end. dDAVP infusion induced a statistically significant shortening of the bleeding time from 9 min (range 6.5-15.5) to 6 min (range 4.5-9.5) at 1 h after the infusion. The activated partial thromboplastin time was significantly shortened at 30 and 60 min after dDAVP infusion. Plasma levels of factor VIII, XI and XII coagulant activities were significantly increased at all sampling times after dDAVP infusion. The maximum increase over basal values in plasma levels of factor VIII, XI and XII was 63, 22 and 40%, respectively. dDAVP did not induce any significant changes of prothrombin time, thrombin clotting time, fibrinogen, plasma levels of factor II, V, VII, IX, X, factor XII antigen, protein C (activity and antigen), antithrombin III, plasminogen and α₂-antiplasmin. Placebo infusion did not produce any significant changes in the evaluated parameters. We conclude that dDAVP can positively influence the hemostatic system in patients with liver cirrhosis. The clinical relevance of this hemostatic improvement deserves further evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Desmopressin on Hemostasis in Patients with Liver Cirrhosis

Agnelli

Parise²,

Levi³

et al. 1995

Pathophysiol Haemos Thromb

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“…The infusion of <500 mL of FFP seldom corrects the PT by more than 2-3 s [142,147]. In vitro, the addition of FFP to plasma of patients with cirrhosis proved ineffective in increasing thrombin generation [148,149]. It is important to realize that cut-off values for PT employed to trigger infusion are arbitrarily set and not based on clinical trial data.…”

Section: Fresh Frozen Plasmamentioning

confidence: 99%

“…Administration of prothrombin complex concentrates improves PT in about 50% of patients with cirrhosis [145,149]. This improvement was attained at a mean dosage of 1500 mL, and associated with an increase in thrombin-antithrombin complexes, that are markers of excessive in vivo thrombin generation [149]. Thrombotic events did not occur during infusion, but other complications, including heparininduced thrombocytopenia, were observed [151,152].…”

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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“…The use of 4F-PCC in patients with cirrhosis has been largely limited to case series and expert opinions [31,32]. Studies such as the PROTON trial are currently investigating PCC use in chronic liver disease [33].…”

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K. The effectiveness of these treatments is estimated by international normalized ratio (INR), an imprecise measure of coagulation in the setting of cirrhosis. Transfusion with FFP may lead to detrimental side effects, including worsening volume overload and increased portal hypertension. We present a case of a 60-year-old patient intubated for acute hypoxic respiratory failure secondary to volume overload who subsequently developed bilateral pneumothoraces, requiring immediate chest tube placement. In this case, the patient had ongoing hepatic decompensation with volume overload and acute worsening of coagulopathy with an INR of 4.2. In this setting, 4-Factor Prothrombin Complex Concentrate (4F-PCC) was chosen to correct coagulation parameters with a low infusion volume. One hour following administration, INR was 1.5. Chest tubes were placed bilaterally and oxygenation improved without bleeding complications. While the data is still lacking, 4F-PCC may be considered for urgent and emergency situations in cirrhotic patients.

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Correction of Abnormal Coagulation in Chronic Liver Disease by Combined Use of Fresh-Frozen Plasma and Prothrombin Complex Concentrates

Cited by 90 publications

References 11 publications

Effects of Desmopressin on Hemostasis in Patients with Liver Cirrhosis

Effects of Desmopressin on Hemostasis in Patients with Liver Cirrhosis

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

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