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Coagulopathy in acute liver failure.

Best Pract Res Clin Gastroenterol

December 2024

Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

Acute liver failure (ALF) is a rare but rapidly progressing syndrome, marked by severe liver dysfunction and altered mental status. While definitions of ALF vary across different guidelines, with timelines ranging from 4 to 26 weeks between jaundice onset and encephalopathy, the key defining features remain encephalopathy and coagulopathy. Elevated coagulation markers, particularly prothrombin time and international normalized ratio, have traditionally been associated with bleeding risks.

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Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design And Methods: This was a sub-study of an international, prospective, observational cohort.

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Viscoelastic hemostatic assays (VHAs) have become a valuable tool in guiding transfusion therapy, particularly in trauma care. While various forms of VHA exist, all provide a quantitative assessment of clot kinetics, strength, and dissolution. Studies have demonstrated that VHA can reduce both mortality and utilization of blood products in the general population.

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Detection of enoxaparin and argatroban by use of the novel viscoelastic coagulometer ClotPro.

Sci Rep

November 2024

Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Währinger Gürtel 18-20, Wien, Vienna, 1090, Austria.

Article Synopsis
  • The study investigates point-of-care diagnostic tests for monitoring the anticoagulants enoxaparin and argatroban in critically ill patients who face risks of thrombosis and bleeding.
  • Blood samples from twelve healthy volunteers were used to evaluate the performance of the ClotPro viscoelastic coagulometer alongside traditional coagulation tests.
  • Results indicated that the RVV test for enoxaparin is not reliable, while the ECA test shows strong correlation and may be a better option for accurately detecting argatroban levels.
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This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of procedures like paracentesis, endoscopic therapy, and various interventional procedures. As such, this paper aims to provide a comprehensive analysis of current data, guidelines, and practices for managing coagulation in cirrhotic patients, with a focus on minimizing bleeding risk while avoiding unnecessary correction with blood products.

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