A note on Hepatic anticoagulation

Though it is true that hepatic patients are more prone to bleed but there are other reasons for it like thrombocytopenia, dysfunctional platelets or blood flow variations. It would be a mistake to read increase prothrombin time (PT) or international normalized ratio (INR) as a sign of anticoagulation in patients with liver insufficiency. Hepatic patients with increase INR are not auto-anticoagulated. In most cases due to slow and chronic nature of the liver diseases body achieves a so called "rebalanced" hemostasis. Thromboelastography (TEG) or thromboelastometry (ROTEM) are said to be more reliable as they reflect dynamic changes in clot formation and lysis.


Reference:

Northup PG, Caldwell SH. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol 2013; 11:1064.