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Hepatic coagulopathy

Authoring team

The liver plays an important role in coagulation:

  • synthesis of coagulation factors I, II, V, VII, IX, X. Vitamin K dependent factors - II, VII, IX and X - and Factor V are affected first in disease. Factor VII is the earliest of all to decline because of its short half-life (6 hours). Fibrinogen (factor I) synthesis is affected only in severe disease.

  • inhibition of fibrinolysis / coagulation - the liver is responsible for synthesising plasma anticoagulant proteins, e.g. protein C, protein S and antithrombin III.

  • clearance of activated coagulation factors - fibrin and tissue plasminogen activator (tPA) are removed from the circulation by the liver's reticuloendothelial system

  • absorption of vitamin K - malabsorption occurs in disease

Impairment of any of these mechanisms predisposes to bleeding.

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