Patients with liver disease often have blood results that give an appearance of a significant bleeding risk;

Patients with liver disease often have blood results that give an appearance of a significant bleeding risk;

  • Low platelets

  • Prolonged PT/APTT

  • Low fibrinogen

However…patients with liver disease often have a ‘rebalancing’ of haemostasis…

This occurs because when procoagulant factors reduce, so do natural anticoagulants

Some more considerations;

  • Spontaneous bleeding & bleeding post minimally invasive procedures are both low

  • FFP transfusion often leads to minimal improvement in PT (no impact if under 19s)

-FFP transfusion could also increase portal pressures, and this is a known risk for variceal haemorrhage

  • The American association for the study of liver disease guidelines advise against checking INR or giving FFP in variceal haemorrhage

A study of ICU patients with liver disease identified that a fibrinogen of under 0.6g/L and platelet count of <30 x 10^9/L were most predictive of bleeding suggesting that these should be relied upon more than PT results.

SO…treating the numbers with FFP transfusion is unlikely to give benefit in most pts. & may➡️harm. A v. low platelet count or fibrinogen are more likely to be predictive of bleeding