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Semin Thromb Hemost 2015; 41(05): 520-526
DOI: 10.1055/s-0035-1550431
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Bleeding and Thrombosis in Critically Ill Patients with Liver Disease

Lara N. Roberts
1   Department of Haematological Medicine, Kings College Hospital, London, United Kingdom
,
William Bernal
2   Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, United Kingdom
› Author Affiliations
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Publication History

Publication Date:
16 June 2015 (online)

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Abstract

Bleeding frequently complicates end-stage chronic liver disease, and may follow procedures which are required for effective care of patients with liver failure. Thrombosis is increasingly recognized as common, important, and potentially preventable. Standard laboratory tests may not be useful in predicting bleeding or thrombotic risk or guiding therapy, and functional testing serves a more useful role. A state of rebalanced hemostasis exists in many patients, with hypocoagulability present only in a minority. Approaches to management are poorly supported by high-quality evidence; in this review, a practical pragmatic approach to care and minimization of procedure-related risk is discussed. General measures include the correction of systemic factors that may affect coagulation status, prevention and treatment of infection, and individualized coagulation support therapies for specific clinical situations and procedures.

Keywords

bleeding - thrombosis - liver failure - procedures - coagulation support
 

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