The coagulopathy of acute liver failure and implications for intracranial pressure monitoring

Santiago J. Munoz, K. Rajender Reddy, William Lee, W. M. Lee, Anne Larson, Oren Fix, Timothy Davern, Lawrence Liu, Timothy McCashland, J. Eileen Hay, Natalie Murray, A. Obaid S. Shaikh, Andres Blei, Daniel Ganger, Atif Zaman, Steven Han, Robert Fontana, Brendan McGuire, Ray Chung, Robert BrownAdrian Reuben, Santiago Munoz, Rajender Reddy, R. Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Introduction: The development of coagulopathy in acute liver failure (ALF) is universal. The severity of the coagulopathy is often assessed by determination of the prothrombin time and International Normalized Ratio (INR). Discussion: In more than 1,000 ALF cases, the severity of the coagulopathy was moderate in 81% (INR 1.5-5.0), severe in 14% (INR 5.0-10.0), and very severe in 5% (INR > 10.0). Certain etiologies were associated with more severe coagulopathy, whereas ALF caused by fatty liver of pregnancy had the least severe coagulopathy. Methods: Management consisted of transfusions of FFP in 92%. Overall, FFP administered during the first week of admission amounted to 13.7 ± 15 units. Results: Patients who received an ICP monitor had significantly more FFP transfused than those managed without ICP monitor (22.7 ± 2.4 vs. 12.3 ± 0.8 units FFP; P < 0.001). Only a minority of patients developed gastrointestinal bleeding or had an intracranial pressure monitor installed. Conclusion: Further research is necessary to explore the reasons clinicians transfuse ALF patients with large amounts of FFP in the absence of active bleeding or invasive procedures.

Original languageEnglish (US)
Pages (from-to)103-107
Number of pages5
JournalNeurocritical Care
Issue number1
StatePublished - Aug 2008
Externally publishedYes


  • Cerebral edema
  • Clotting
  • Coagulopathy
  • Factor VII
  • Hepatitis
  • Hypothermia
  • Intracranial pressure
  • Liver
  • Plasma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology


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