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Procoagulant therapeutics in liver disease: a critique and clinical rationale

Neeral L Shah1, Nicolas M Intagliata1, Patrick G Northup1

  • 1Division of Gastroenterology and Hepatology, PO Box 800708, University of Virginia, Charlottesville, VA 22908, USA.

Nature Reviews. Gastroenterology & Hepatology
|July 16, 2014
PubMed

The complex nature of haemostasis in patients with liver disease can result in bleeding and/or thrombosis. These opposing outcomes, which have multiple contributing factors, can pose diagnostic and therapeutic dilemmas for physicians. With the high rate of haemorrhagic complications in patients with cirrhosis, we examine the various procoagulants available for use in this population. In this Review, we describe the clinical and current rationale for using each of the currently available procoagulants-vitamin K, fresh frozen plasma (FFP), cryoprecipitate, platelets, recombinant factor VIIa (rFVIIa), antifibrinolytics, prothrombin concentrate complexes (PCC), desmopressin and red blood cells. By examining the evidence and use of these agents in liver disease, we provide a framework for targeted, goal-directed therapy with procoagulants.

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