title: Procoagulant therapeutics in liver disease: a critique and clinical rationale.
abstract: The complex nature of haemostasis in patients with liver disease can result in bleeding and/or thrombosis. These opposing outcomes, which have multiple contributing factors, can pose diagnostic and therapeutic dilemmas for physicians. With the high rate of haemorrhagic complications in patients with cirrhosis, we examine the various procoagulants available for use in this population. In this Review, we describe the clinical and current rationale for using each of the currently available procoagulants-vitamin K, fresh frozen plasma (FFP), cryoprecipitate, platelets, recombinant factor VIIa (rFVIIa), antifibrinolytics, prothrombin concentrate complexes (PCC), desmopressin and red blood cells. By examining the evidence and use of these agents in liver disease, we provide a framework for targeted, goal-directed therapy with procoagulants.
authors.affiliation: Division of Gastroenterology and Hepatology, PO Box 800708, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Neeral L
authors.initials: NL
authors.lastname: Shah
authors.affiliation: Division of Gastroenterology and Hepatology, PO Box 800708, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Intagliata
authors.affiliation: Division of Gastroenterology and Hepatology, PO Box 800708, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.affiliation: Division of Gastroenterology and Hepatology, PO Box 800708, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Division of Gastroenterology and Hepatology, PO Box 800708, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003029:Coagulants / Q000627:therapeutic use*; D003894:Deamino Arginine Vasopressin; D017707:Erythrocyte Transfusion; D005169:Factor VIII / Q000627:therapeutic use; D015942:Factor VIIa / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D010949:Plasma / Q000378:metabolism; D011994:Recombinant Proteins / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use
chemical_list: D000933:Antifibrinolytic Agents; D003029:Coagulants; D011994:Recombinant Proteins; C026912:cryoprecipitate coagulum; D014812:Vitamin K; D005169:Factor VIII; D005340:Fibrinogen; C103587:recombinant FVIIa; D015942:Factor VIIa; D003894:Deamino Arginine Vasopressin