SCCM Resource Library-Is Blood Thicker Than Water? Management of Coagulopathy in Liver Failure

Video Transcription

Video Summary

Stephanie Bass, a medical ICU pharmacist at Cleveland Clinic, discusses the management of coagulopathy in liver failure. She reviews the 2020 SCCM guideline recommendations and the use of viscoelastic testing and reversal agents. Viscoelastic testing is suggested over traditional measures such as INR, platelet, and fibrinogen for evaluating bleeding and thrombosis risk in patients with liver failure. Additionally, viscoelastic testing is recommended over traditional measures for bleeding risk prior to procedures. Viscoelastic testing provides real-time measurement of clot formation and breakdown. However, the lack of well-defined transfusion thresholds limits its applicability. Several studies have evaluated viscoelastic testing for transfusion guidance and found a significant reduction in transfusions when guided by viscoelastic testing compared to standard of care. For reversing coagulopathy, recombinant activated factor VII and prothrombin complex concentrates (PCCs) have been investigated. PCCs have shown promise when dosed at less than 25 to 30 units per kilo. Thrombopoietin receptor agonists are FDA-approved to increase platelet count but come with an increased risk of thrombotic events. Antifibrinolytics have limited data for use in liver disease, and a recent study showed potential harm and increased risk of venous thromboembolism.

Asset Subtitle

Hematology, GI and Nutrition, 2022

Asset Caption

SCCM's Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU were published in March 2020. This session will cover these recommendations and continued controversies surrounding managing these complex patients. The guidelines cover recommendations for cardiovascular, endocrine, hematologic, pulmonary, and renal considerations. This session will cover selected topics, including hemodynamics and resuscitation, coagulopathy, and renal complications.

Meta Tag

Content Type Presentation

Knowledge Area Hematology

Knowledge Area GI and Nutrition

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Coagulation

Tag Liver

Year 2022

Keywords

coagulopathy

liver failure

viscoelastic testing

reversal agents

transfusion guidance

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