Liver failure

Abstract

Liver plays crucial roles in the production and metabolism of most coagulation factors and inhibitors. Understanding of coagulopathy in patients with liver failure has evolved in the recent years. Many patients with liver failure maintain a fragile balance of procoagulant and anticoagulant proteins. This so-called rebalanced hemostasis is easily disrupted by trauma and surgery, which are accompanied by hemorrhage, hemodilution, and various exogenous procoagulant interventions. Point-of-care (POC) whole-blood coagulation tests have been increasingly implemented to assess complex coagulopathy that may develop during a major trauma repair or surgery. POC-guided, targeted hemostatic therapy allows a major shift from routine administrations of plasma and platelets to patients with liver failure who may develop serious complications including circulatory overload. Viscoelastic POC coagulation monitoring also allows timely and selective uses of plasma-derived recombinant factor concentrates and antifibrinolytics in patients with liver failure. Further studies are warranted to optimize anticoagulant regimen in patients with liver failure who are at risk for perioperative thromboembolism.