The coagulopathy of acute liver failure and implications for intracranial pressure monitoring

Santiago J. Munoz; K. Rajender Reddy; William Lee; W. M. Lee; Anne Larson; Oren Fix; Timothy Davern; Lawrence Liu; Timothy McCashland; J. Eileen Hay; Natalie Murray; A. Obaid S. Shaikh; Andres Blei; Daniel Ganger; Atif Zaman; Steven Han; Robert Fontana; Brendan McGuire; Ray Chung; Robert Brown; Adrian Reuben; Santiago Munoz; Rajender Reddy; R. Todd Stravitz; Lorenzo Rossaro; Raj Satyanarayana; Tarek Hassanein

doi:10.1007/s12028-008-9087-6

The coagulopathy of acute liver failure and implications for intracranial pressure monitoring

Santiago J. Munoz, K. Rajender Reddy, William Lee, W. M. Lee, Anne Larson, Oren Fix, Timothy Davern, Lawrence Liu, Timothy McCashland, J. Eileen Hay, Natalie Murray, A. Obaid S. Shaikh, Andres Blei, Daniel Ganger, Atif Zaman, Steven Han, Robert Fontana, Brendan McGuire, Ray Chung, Robert BrownAdrian Reuben, Santiago Munoz, Rajender Reddy, R. Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein

Gastroenterology

Research output: Contribution to journal › Article › peer-review

44 Scopus citations

Abstract

Introduction: 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). Discussion: 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. Conclusion: 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.

Original language	English (US)
Pages (from-to)	103-107
Number of pages	5
Journal	Neurocritical Care
Volume	9
Issue number	1
DOIs	https://doi.org/10.1007/s12028-008-9087-6
State	Published - Aug 2008

Keywords

Cerebral edema
Clotting
Coagulopathy
Factor VII
Hepatitis
Hypothermia
Intracranial pressure
Liver
Plasma

ASJC Scopus subject areas

Clinical Neurology
Critical Care and Intensive Care Medicine

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Munoz, S. J., Rajender Reddy, K., Lee, W., Lee, W. M., Larson, A., Fix, O., Davern, T., Liu, L., McCashland, T., Hay, J. E., Murray, N., Shaikh, A. O. S., Blei, A., Ganger, D., Zaman, A., Han, S., Fontana, R., McGuire, B., Chung, R., ... Hassanein, T. (2008). The coagulopathy of acute liver failure and implications for intracranial pressure monitoring. Neurocritical Care, 9(1), 103-107. https://doi.org/10.1007/s12028-008-9087-6

The coagulopathy of acute liver failure and implications for intracranial pressure monitoring. / Munoz, Santiago J.; Rajender Reddy, K.; Lee, William; Lee, W. M.; Larson, Anne; Fix, Oren; Davern, Timothy; Liu, Lawrence; McCashland, Timothy; Hay, J. Eileen; Murray, Natalie; Shaikh, A. Obaid S.; Blei, Andres; Ganger, Daniel; Zaman, Atif; Han, Steven; Fontana, Robert; McGuire, Brendan; Chung, Ray; Brown, Robert; Reuben, Adrian; Munoz, Santiago; Reddy, Rajender; Stravitz, R. Todd; Rossaro, Lorenzo; Satyanarayana, Raj; Hassanein, Tarek.

In: Neurocritical Care, Vol. 9, No. 1, 08.2008, p. 103-107.

Research output: Contribution to journal › Article › peer-review

Munoz, SJ, Rajender Reddy, K, Lee, W, Lee, WM, Larson, A, Fix, O, Davern, T, Liu, L, McCashland, T, Hay, JE, Murray, N, Shaikh, AOS, Blei, A, Ganger, D, Zaman, A, Han, S, Fontana, R, McGuire, B, Chung, R, Brown, R, Reuben, A, Munoz, S, Reddy, R, Stravitz, RT, Rossaro, L, Satyanarayana, R & Hassanein, T 2008, 'The coagulopathy of acute liver failure and implications for intracranial pressure monitoring', Neurocritical Care, vol. 9, no. 1, pp. 103-107. https://doi.org/10.1007/s12028-008-9087-6

Munoz, Santiago J. ; Rajender Reddy, K. ; Lee, William ; Lee, W. M. ; Larson, Anne ; Fix, Oren ; Davern, Timothy ; Liu, Lawrence ; McCashland, Timothy ; Hay, J. Eileen ; Murray, Natalie ; Shaikh, A. Obaid S. ; Blei, Andres ; Ganger, Daniel ; Zaman, Atif ; Han, Steven ; Fontana, Robert ; McGuire, Brendan ; Chung, Ray ; Brown, Robert ; Reuben, Adrian ; Munoz, Santiago ; Reddy, Rajender ; Stravitz, R. Todd ; Rossaro, Lorenzo ; Satyanarayana, Raj ; Hassanein, Tarek. / The coagulopathy of acute liver failure and implications for intracranial pressure monitoring. In: Neurocritical Care. 2008 ; Vol. 9, No. 1. pp. 103-107.

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abstract = "Introduction: 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). Discussion: 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. Conclusion: 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.",

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AU - Munoz, Santiago J.

AU - Rajender Reddy, K.

AU - Lee, William

AU - Lee, W. M.

AU - Larson, Anne

AU - Fix, Oren

AU - Davern, Timothy

AU - Liu, Lawrence

AU - McCashland, Timothy

AU - Hay, J. Eileen

AU - Murray, Natalie

AU - Shaikh, A. Obaid S.

AU - Blei, Andres

AU - Ganger, Daniel

AU - Zaman, Atif

AU - Han, Steven

AU - Fontana, Robert

AU - McGuire, Brendan

AU - Chung, Ray

AU - Brown, Robert

AU - Reuben, Adrian

AU - Munoz, Santiago

AU - Reddy, Rajender

AU - Stravitz, R. Todd

AU - Rossaro, Lorenzo

AU - Satyanarayana, Raj

AU - Hassanein, Tarek

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N2 - Introduction: 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). Discussion: 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. Conclusion: 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.

AB - Introduction: 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). Discussion: 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. Conclusion: 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.

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KW - Liver

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