Liver Disease
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General Principles
Liver disease can impair hemostasis (see Figure 20-1) due to a reduction in synthesis of most coagulation factors. Cholestasis, which leads to impaired vitamin K absorption, can also impair hemostasis because of decreased production of Factors II, VII, IX, and X. Patients who have stable liver disease typically have a mild coagulopathy. Liver disease may produce other hemostatic complications that include thrombocytopenia due to splenic sequestration, DIC, and hyperfibrinolysis. Although PT/INR and aPTT prolongations imply an increased risk of bleeding, they do not reflect concurrent reductions in protein C and protein S nor compensatory increases in factor VIII and vWF.
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General Principles
Liver disease can impair hemostasis (see Figure 20-1) due to a reduction in synthesis of most coagulation factors. Cholestasis, which leads to impaired vitamin K absorption, can also impair hemostasis because of decreased production of Factors II, VII, IX, and X. Patients who have stable liver disease typically have a mild coagulopathy. Liver disease may produce other hemostatic complications that include thrombocytopenia due to splenic sequestration, DIC, and hyperfibrinolysis. Although PT/INR and aPTT prolongations imply an increased risk of bleeding, they do not reflect concurrent reductions in protein C and protein S nor compensatory increases in factor VIII and vWF.
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