In patients with abnormal coagulation testing results in the setting of liver disease, INR and PT may be best used to provide the practitioner with information about the synthetic function of the liver but not to assess hemorrhagic risk.

The evidence supports a “watchful waiting” approach to the transfusion of platelets and fresh-frozen plasma with a bedside assessment of the patient’s actual hemorrhagic risk.

The safest assumption that a practitioner in an acute and critical setting can make about any cirrhotic patient is that, even on their healthiest day, they are at an elevated risk of adverse outcomes that may be associated with an adverse thrombotic rather than the commonly feared catastrophic hemorrhagic event.

Read More