PMID- 31689724 OWN - NLM STAT- MEDLINE DCOM- 20201007 LR - 20201007 IS - 1440-1746 (Electronic) IS - 0815-9319 (Linking) VI - 35 IP - 5 DP - 2020 May TI - Coagulation abnormalities, bleeding, thrombosis, and management of patients with acute liver failure in Australia and New Zealand. PG - 846-854 LID - 10.1111/jgh.14876 [doi] AB - BACKGROUND AND AIM: To study the management of coagulation and hematological derangements among severe acute liver failure (ALF) patients in Australia and New Zealand liver transplant intensive care units (ICUs). METHODS: Analysis of key baseline characteristics, etiology, coagulation and hematological tests, use of blood products, thrombotic complications, and clinical outcomes during the first ICU week. RESULTS: We studied 62 ALF patients. The first day median peak international normalized ratio was 5.5 (inter-quartile range [IQR] 3.8-8.7), median longest activated partial thromboplastin time was 62 s (IQR 44-87), and median lowest fibrinogen was 1.1 (IQR 0.8-1.6) g/L. Fibrinogen was only measured in 85% of patients, which was less than other tests (P < 0.0001). Median initial lowest platelet count was 83 (IQR 41-122) x 10(9) /L. Overall, 58% of patients received fresh frozen plasma, 40% cryoprecipitate, 35% platelets, and 15% prothrombin complex concentrate. Patients with bleeding complications (19%) had more severe overall hypofibrinogenemia and thrombocytopenia. Thrombotic complications were less common (10% of patients), were not associated with consistent patterns of abnormal hemostasis, and were not immediately preceded by clotting factor administration and half occurred only after liver transplantation surgery. CONCLUSION: In ALF patients admitted to dedicated Australia and New Zealand ICUs, fibrinogen was measured less frequently than other coagulation parameters but, together with platelets, appeared more relevant to bleeding risk. Blood products and procoagulant factors were administered to most patients at variable levels of hemostatic derangement, and bleeding complications were more common than thrombotic complications. This epidemiologic information and practice variability provide baseline data for the design and powering of interventional studies. CI - (c) 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. FAU - Warrillow, Stephen AU - Warrillow S AUID- ORCID: 0000-0002-7240-4106 AD - Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia. AD - Department of Medicine and Surgery, The University of Melbourne, Melbourne, Victoria, Australia. FAU - Fisher, Caleb AU - Fisher C AD - Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia. FAU - Tibballs, Heath AU - Tibballs H AD - Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia. FAU - Bailey, Michael AU - Bailey M AD - Department of Medicine and Surgery, The University of Melbourne, Melbourne, Victoria, Australia. AD - Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia. FAU - McArthur, Colin AU - McArthur C AD - Medical Research Institute of New Zealand, Auckland, New Zealand. AD - Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. FAU - Lawson-Smith, Pia AU - Lawson-Smith P AD - Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. FAU - Prasad, Bheemasenachar AU - Prasad B AD - South Metropolitan Health Service, Rockingham, Western Australia, Australia. FAU - Anstey, Matthew AU - Anstey M AD - Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. FAU - Venkatesh, Bala AU - Venkatesh B AD - Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia. FAU - Dashwood, Gemma AU - Dashwood G AD - Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia. FAU - Walsham, James AU - Walsham J AD - Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Australia. FAU - Holt, Andrew AU - Holt A AD - Department of Intensive Care, Flinders Medical Centre, Adelaide, South Australia, Australia. FAU - Wiersema, Ubbo AU - Wiersema U AD - Department of Intensive Care, Flinders Medical Centre, Adelaide, South Australia, Australia. FAU - Gattas, David AU - Gattas D AD - Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia. FAU - Zoeller, Matthew AU - Zoeller M AD - Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia. FAU - Garcia Alvarez, Mercedes AU - Garcia Alvarez M AD - Department of Anesthesiology and Pain Medicine, Hospital Santa Creu i Sant Pau, University of Barcelona, Barcelona, Spain. FAU - Bellomo, Rinaldo AU - Bellomo R AD - Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia. AD - Department of Medicine and Surgery, The University of Melbourne, Melbourne, Victoria, Australia. AD - Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia. AD - Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, Australia. AD - Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia. LA - eng PT - Journal Article DEP - 20191105 PL - Australia TA - J Gastroenterol Hepatol JT - Journal of gastroenterology and hepatology JID - 8607909 RN - 0 (Blood Coagulation Factors) RN - 0 (Hematologic Agents) SB - IM MH - Adult MH - Australia/epidemiology MH - Blood Coagulation Disorders/blood/epidemiology/*etiology MH - Blood Coagulation Factors/*administration & dosage MH - Blood Coagulation Tests MH - Female MH - Hematologic Agents/*administration & dosage MH - Hemorrhage/blood/epidemiology/*etiology MH - Hemostasis MH - Humans MH - Liver Failure, Acute/blood/epidemiology/*etiology MH - Male MH - Middle Aged MH - New Zealand/epidemiology MH - Thrombosis/blood/epidemiology/*etiology MH - Young Adult OTO - NOTNLM OT - acute liver failure OT - bleeding OT - coagulopathy OT - encephalopathy emergency liver transplant OT - thrombosis EDAT- 2019/11/07 06:00 MHDA- 2020/10/08 06:00 CRDT- 2019/11/06 06:00 PHST- 2019/08/26 00:00 [received] PHST- 2019/09/19 00:00 [revised] PHST- 2019/09/21 00:00 [accepted] PHST- 2019/11/07 06:00 [pubmed] PHST- 2020/10/08 06:00 [medline] PHST- 2019/11/06 06:00 [entrez] AID - 10.1111/jgh.14876 [doi] PST - ppublish SO - J Gastroenterol Hepatol. 2020 May;35(5):846-854. doi: 10.1111/jgh.14876. Epub 2019 Nov 5.