The coagulopathy of acute liver failure and implications for intracranial pressure monitoring.
BACKGROUND
The development of coagulopathy in acute liver failure (ALF) is universal. The severity of the coagulopathy is often assessed by determination of the prothrombin time and International Normalized Ratio (INR).


CONCLUSIONS
In more than 1,000 ALF cases, the severity of the coagulopathy was moderate in 81% (INR 1.5-5.0), severe in 14% (INR 5.0-10.0), and very severe in 5% (INR > 10.0). Certain etiologies were associated with more severe coagulopathy, whereas ALF caused by fatty liver of pregnancy had the least severe coagulopathy.


METHODS
Management consisted of transfusions of FFP in 92%. Overall, FFP administered during the first week of admission amounted to 13.7 +/- 15 units.


RESULTS
Patients who received an ICP monitor had significantly more FFP transfused than those managed without ICP monitor (22.7 +/- 2.4 vs. 12.3 +/- 0.8 units FFP; P < 0.001). Only a minority of patients developed gastrointestinal bleeding or had an intracranial pressure monitor installed.


CONCLUSIONS
Further research is necessary to explore the reasons clinicians transfuse ALF patients with large amounts of FFP in the absence of active bleeding or invasive procedures.
Munoz
Santiago J
SJ
Division of Hepatology, Albert Einstein Medical Center, 5401 Old York Road, Klein Bldg., Suite 509, Philadelphia, PA 19141, USA. orolonco@comcast.net
Rajender Reddy
K
K
Lee
William
W
D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D006801:Humans; D007427:Intracranial Pressure; D017114:Liver Failure, Acute / Q000150:complications* / Q000209:etiology; D008991:Monitoring, Physiologic; D010949:Plasma; D011517:Prothrombin Time; D012042:Registries; D012720:Severity of Illness Index