Piotr Czempik: Rethinking Coagulation in Acute Liver Dysfunction
Piotr Czempik, Chair of Department of Anesthesiology and Intensive Care at Medical University of Silesia, shared on LinkedIn:
”Rethinking Coagulation in Acute Liver Dysfunction
Conventional wisdom tells us that a high INR equals high bleeding risk.
But is that always true?
We recently reported a case of a 61‑year‑old ICU patient with acute liver dysfunction, stage 3 AKI, and INR 3.2 who required dialysis catheter insertion.
Despite the alarming lab values, no bleeding occurred.
Why? Because viscoelastic hemostatic assays (ROTEM) revealed preserved clot propagation and firmness, despite impaired initiation.
Guided by these results, we avoided prophylactic FFP transfusion and proceeded safely with catheter placement.
Key takeaways:
- INR alone is not a reliable predictor of bleeding risk in acute liver failure.
- VHAs provide a global, functional view of hemostasis, often uncovering rebalanced or even hypercoagulable states.
- Routine FFP transfusion before invasive procedures may expose patients to unnecessary risks.
- Individualized risk assessment using VHAs can improve safety and reduce inappropriate transfusion.
- This case adds to growing evidence that we need to move beyond conventional coagulation tests in critical care decision‑making.
How do you approach bleeding risk assessment in patients with acute liver dysfunction?
Have VHAs changed your practice?”
Read the full article here.
Article: No bleeding during a dialysis catheter insertion in a patient with INR 3.2 due to acute liver dysfunction
Authors: Piotr Czempik, Tomasz Jaworski
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