Coagulopathy Management in Cirrhosis

Patient Management

In patients with stable cirrhosis undergoing common gastrointestinal procedures, the American Gastroenterological Association recommends against the routine use of blood products (fresh frozen plasma and platelets) for bleeding prophylaxis 2, 3
The European Association for the Study of the Liver suggests that routine correction of laboratory abnormalities (prothrombin time, APTT, platelet count, fibrinogen) before invasive procedures is not recommended 1, 4
For high-risk procedures with a platelet count between 20-50 × 10⁹/L, the infusion of platelet concentrates or TPO-R agonists should be considered on a case-by-case basis, not routinely 4, 5
In high-risk procedures with a very low platelet count (<20 × 10⁹/L), platelet infusion or TPO-R agonists should be considered on a case-by-case basis 5

In patients with cirrhosis and active variceal bleeding, if hemostasis is achieved with drugs that reduce portal hypertension and endoscopic treatment, correction of hemostatic abnormalities is not indicated 1, 4
In case of failure to control variceal bleeding, the decision to correct hemostasis should be made on a case-by-case basis 1, 4
The American Association for the Study of Liver Diseases recommends against the use of tranexamic acid in patients with cirrhosis and active variceal bleeding 1, 4

The risk of developing deep vein thrombosis/pulmonary embolism is at least as high in patients with cirrhosis as in the general population 1
In hospitalized patients with cirrhosis who meet standard guidelines for venous thromboembolism prophylaxis, standard anticoagulant prophylaxis is suggested 2, 6
In patients with cirrhosis and non-tumoral portal vein thrombosis, anticoagulation is suggested over no anticoagulation 2, 6