Treating coagulopathy in liver disease with plasma transfusions or recombinant factor VIIa: An evidence-based review

Glenn Ramsey*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

In severe liver disease, poor synthetic function leads to characteristic deficiencies in numerous coagulation factors, and plasma transfusions are frequently administered to treat or prevent bleeding. This chapter reviews the available English-language randomized controlled trials, evidence-based practice guidelines, and observational studies relevant to establishing criteria for plasma transfusions in liver disease. The alternatives of pathogen-inactivated plasmas and recombinant factor VIIa were also reviewed from this perspective. In current guidelines, plasma transfusions are justified when haemostasis is needed for bleeding or invasive procedures, and the prothrombin time (PT) or partial thromboplastin time (PTT) is > 1.5 times normal (mid-normal or, for PTT, sometimes upper limit). Conversion of the PT to the International Normalized Ratio has not been validated in liver disease. Solvent-detergent or methylene-blue treatments alter various clotting factors, which might affect efficacy in liver disease. Recombinant factor VIIa improves laboratory clotting measurements, but reduction of bleeding is less well established to date.

Original languageEnglish (US)
Pages (from-to)113-126
Number of pages14
JournalBest Practice and Research: Clinical Haematology
Volume19
Issue number1
DOIs
StatePublished - Mar 1 2006

Keywords

  • Blood coagulation disorders
  • Blood component transfusion
  • Factor VIIa
  • Liver diseases
  • Liver transplantation
  • Plasma

ASJC Scopus subject areas

  • Oncology
  • Clinical Biochemistry

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