Management of hepatic coagulopathy

Coagulopathy and haemorrhage are a common consequence of ALF, because of:

• consumption, and inadequate synthesis, of clotting factors and their inhibitors
• thrombocytopaenia

The best means of preventing or managing coagulopathy has not been clearly demonstrated:

• fresh frozen plasma - FFP has not been proved to be effective in this context, and it is currently used only in patients who are bleeding or awaiting an invasive procedure. Infusion of a salt, water and nitrogen load may contribute to the development of cerebral oedema.
  
• plasma exchange - it has been suggested that repeated courses of high-volume plasma exchange may prolong survival until liver regeneration begins, or transplantation can be performed. The beneficial effect of plasma exchange has not been confirmed in a randomised controlled trial.
  
• parenteral vitamin K - improves coagulation
  
• ranitidine - 50 mg in 20 ml given over 2 minutes, three times daily, to reduce stress induced erosions

Reference

1. Wendon J et al; European Association for the Study of the Liver. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017 May;66(5):1047-81.