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A Misguided Contraindication: International Normalized Ratio in Acute Liver Failure Precluding Thrombolysis for

Micah T Long1, Paul D Gallo1, Laura L Hammel1

  • 1From the Departments of Anesthesiology and.

A&A Practice
|July 28, 2018
PubMed

Massive pulmonary embolism and its treatment with thrombolysis both carry grave risks. Optimal management hinges on determining the risk-to-benefit ratio of thrombolytic administration. For patients with liver dysfunction, assessing bleeding risk is challenging because they may have elevations in the international normalized ratio yet be hypercoagulable. We describe a patient with massive pulmonary embolism and new-onset liver failure, who-absent contraindications-warranted thrombolysis. Initial laboratory values, however, revealed an elevated international normalized ratio, which precluded lysis, despite a hypercoagulable Thromboelastogram. We believe that viscoelastic testing of coagulation is essential for evaluating coagulation in liver dysfunction, particularly when considering thrombolysis.

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