Clotting Times in Acute Liver Failure

From Ep 184 on the Medicine Feed With Dr Ava Tan

We know that when the liver gets sad, it stops making ALL the things we need for effective clotting. So it's no surprise when you run PT/PTT on that acute liver failure patient and see some very worrying numbers. So, do you rush in with the plasma transfusion? Dr Ava Tan shared these pearls:

• Despite what the clotting tests say, we don't always see clinical bleeding. As liver function declines, all the anti- and pro-coagulants that the liver makes decrease proportionally, often leading to a rebalanced haemostasis rather than outright spontaneous bleeding.

• That means that even if clotting testing (e.g., PT, aPTT, or viscoelastic testing such as TEG or ROTEM) is abnormal, we don't always just transfuse plasma, but rather only give it if the patient does start bleeding.

• And IF your patient does start bleeding and you DO give plasma, we transfuse to control bleeding, not to normalise PT/aPTT. Unlike something simple like anticoagulant toxicity, where we can aim to normalise clotting times, liver failure patients cannot produce new clotting factors, so chasing a normal PT is futile.

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