Coagulopathy considerations in cirrhosis and trauma

Background considerations 

  • Cirrhotic patients tend to have higher morbidity and mortality with trauma-related injuries.
  • No strict guidelines exist for traumatic intracranial hemorrhage and coagulopathy reversal in the cirrhotic trauma patient.
  • Cirrhotic patients have a complex hemostatic profile. While at risk for bleeding episodes, they are also at high risk for thrombotic events regardless of their laboratory values (PT/INR, PTT).
  • Global assays such as thromboelastography (TEG) or thromboelastometry (ROTEM) have been shown in some studies to be more useful tests in determining a true hemostatic state.



  • INR: May be elevated in cirrhosis but it is not a true reflection of bleeding risk and correcting it to reach a target numerical value comes with significant risks (administration of FFP may increase blood pressure, portal pressure due to volume overload)
  • Platelets: Thrombocytopenia can be common as well as co-existent platelet dysfunction; typically transfuse if < 100k in the setting of active severe bleeding
  • Fibrinogen: Essential for clot formation, consider presence of hypofibrinogenemia or dysfibrinogenemia in cirrhosis; if fibrinogen level less than 100-150, consider cryoprecipitate transfusion (1 unit per 10 kg)








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