Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study

Youssef, Wael

doi:10.1016/s0002-9270(03)00241-7

Cited by 108 publications

(74 citation statements)

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“…Not only do these published results suggest that INR may not accurately predict those at high risk of bleeding, but there is also little evidence to suggest that correction of INR by administration of FFP has any beneficial clinical effect 12,13 . Consequently, the potential risk and significant cost associated with blood product transfusion may be avoided in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of International Normalized Ratio to Predict Bleeding Complications in Patients With End-Stage Liver Disease Who Undergo Cardiac Catheterization

Townsend¹,

Heard²,

Powers³

et al. 2012

The American Journal of Cardiology

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Patients with end-stage liver disease frequently need invasive cardiac procedures in preparation for liver transplantation. As a consequence of impaired hepatic function these patients often have a prolonged prothrombin time (PT) and elevated International Normalized Ratio (INR). To determine whether an abnormal PT/INR is predictive of bleeding complications from invasive cardiac procedures, we reviewed retrospectively, for bleeding complications, the databases and case records of our series of patients with advanced cirrhosis who underwent cardiac catheterization. One hundred and fifty-seven patients underwent isolated right heart catheterization (RHC), and 83 underwent left (LHC) or combined left and right sided heart catheterization. INRs ranged from 0.93-2.35. There were no major procedure-related complications. Several patients in each group required blood transfusion for gastrointestinal bleeding, but not for procedure-related bleeding. There was no significant change in hemoglobin after RHC or LHC, and no correlation between pre-procedure INR and change in post-procedure hemoglobin. When comparing patients with normal (≤1.5) and elevated (>1.5) INRs, no significant difference in hemoglobin post-procedure was found in either group. In conclusion, despite an elevated INR, patients with end-stage liver disease can safely undergo invasive cardiac procedures. INR elevation does not predict catheterization-related bleeding complications in this patient population.

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Section: Discussionmentioning

confidence: 99%

Usefulness of International Normalized Ratio to Predict Bleeding Complications in Patients With End-Stage Liver Disease Who Undergo Cardiac Catheterization

Townsend¹,

Heard²,

Powers³

et al. 2012

The American Journal of Cardiology

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“…The aim of FFP infusions is usually either to improve the coagulopathy before invasive procedures or to control ongoing bleeding from various sites in patients with vitamin K-unresponsiveness prolonged prothrombin time. The mean prothrombin time was improved by the infusion of 2–6 units of FFP, but only 12.5% of the retrospective study group and 10% of the prospective study groups showed reversal of their coagulopathy, and higher volume (6 or more units) may be more effective but rarely is employed [96]. However, attention should be directed to complications including the risk of infection, allergic reaction, and acute volume expansion leading to heart failure or pulmonary edema [95, 96].…”

Section: Possible Therapeutic Approaches Of Adamts13 Supplementatimentioning

confidence: 99%

Determination of ADAMTS13 and Its Clinical Significance for ADAMTS13 Supplementation Therapy to Improve the Survival of Patients with Decompensated Liver Cirrhosis

Uemura

Fujimura

et al. 2011

International Journal of Hepatology

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The liver plays a central role in hemostasis by synthesizing clotting factors, coagulation inhibitors, and fibrinolytic proteins. Liver cirrhosis (LC), therefore, impacts on both primary and secondary hemostatic mechanisms. ADAMTS13 is a metalloproteinase, produced exclusively in hepatic stellate cells, and specifically cleaves unusually large von Willebrand factor multimers (UL-VWFM). Deficiency of ADAMTS13 results in accumulation of UL-VWFM, which induces platelet clumping or thrombi under high shear stress, followed by sinusoidal microcirculatory disturbances and subsequent progression of liver injuries, eventually leading to multiorgan failure. The marked imbalance between decreased ADAMTS13 activity (ADAMTS13 : AC) and increased production of UL-VWFM indicating a high-risk state of platelet microthrombi formation was closely related to functional liver capacity, hepatic encephalopathy, hepatorenal syndrome, and intractable ascites in advanced LC. Some end-stage LC patients with extremely low ADAMTS13 : AC and its IgG inhibitor may reflect conditions similar to thrombotic thrombocytopenic purpura (TTP) or may reflect “subclinical TTP.” Hence, cirrhotic patients with severe to moderate deficiency of ADAMTS13 : AC may be candidates for FFP infusion as a source of ADAMTS13 or for recombinant ADAMTS13 supplementation. Such treatments may improve the survival of patients with decompensated LC.

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“…Fresh frozen plasma and platelets (particularly for a platelet count <50,000 mL-1) have often been used to correct coagulopathy. These measures do not adequately correct the coagulopathy, and could potentially induce volume overload and rebound portal hypertension 31 . The use of recombinant factor VII has been shown to improve hemostasis rates, but it does not improve survival 32 .…”

Section: Assesement Of Severity Of the Bleedingmentioning

confidence: 99%

Nonendoscopic Management Strategies for Acute Esophagogastric Variceal Bleeding

Sanyal¹

2014

Gastroenterology Clinics of North America

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Acute variceal bleeding is a potentially life threatening complication of portal hypertension. Management consists of emergent hemostasis, therapy directed at hemodynamic resuscitation, protection of the airway, and prevention and treatment of complications including prophylactic use of antibiotics. Endoscopic treatment remains the mainstay in the management of acute variceal bleeding in combination with pharmacotherapy aimed at reducing portal pressure. Patients failing first-line therapy are triaged for non-endoscopic means of achieving hemostasis such as TIPS, BRTO or surgically created shunt procedures as rescue procedures, the choice depends on the source of bleeding (esophageal or gastric), size of the varices, portal vein patency, presence or absence of gastro-renal shunt, hepatic reserve and local expertise. The current chapter, intends to highlight only the current non endoscopic treatment approaches for control of acute variceal bleeding.

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Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study

Cited by 108 publications

References 0 publications

Usefulness of International Normalized Ratio to Predict Bleeding Complications in Patients With End-Stage Liver Disease Who Undergo Cardiac Catheterization

Usefulness of International Normalized Ratio to Predict Bleeding Complications in Patients With End-Stage Liver Disease Who Undergo Cardiac Catheterization

Determination of ADAMTS13 and Its Clinical Significance for ADAMTS13 Supplementation Therapy to Improve the Survival of Patients with Decompensated Liver Cirrhosis

Nonendoscopic Management Strategies for Acute Esophagogastric Variceal Bleeding

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