UMEM Educational Pearls

Category: Critical Care

Title: Coagulopathy and ALF

Posted: 6/30/2009 by Mike Winters, MD (Updated: 4/1/2023)
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Coagulopathy from Acute Liver Failure

  • ALF is defined as
    • absence of chronic liver disease
    • acute elevation in AST/ALT accompanied by INR > 1.5
    • any degree of mental status change (encephalopathy)
    • illness less than 26 weeks duration
  • The most common cause is acetaminophen toxicity
  • Regarding the coagulopathy that develops with ALF:
    • FFP transfusion is not encouraged, as the volume may exacerbate cerebral edema and it has been shown to be ineffective for improving INR elevations
    • The prophylactic transfusion of platelets for extreme thrombocytopenia is also not recommended for similar reasons


Trotter JF.  Practical management of acute liver failure in the intensive care unit. Curr Opin Crit Care 2009;15:163-7.