Diagnosis and therapy of coagulopathies in patients with liver disease

Although the coagulopathies encountered in patients with liver disease can be multifactorial, the most common cause is underproduction of certain coagulation factors synthesized by the liver. Generally, vitamin K and replacement therapy are all that is necessary. In the rare instance in which the coagulopathy may be complicated by hyperfibrinolysis or disseminated intravascular coagulation, replacement therapy may not suffice and other means of correcting the defect may be necessary. The prothrombin time, partial thromboplastin time, platelet count, fibrinogen concentration, and a test for fibrinolysis are recommended as the initial workup for the bleeding patient with underlying liver disease. Other, more specific tests may be necessary to differentiate the various causes of the defects in the hemostatic mechanism in these patients.