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{
    "pk": 11616,
    "title": "The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting",
    "subtitle": null,
    "abstract": "The international normalized ratio (INR) represents a clinical tool to assess the effectiveness of vitamin-K antagonist therapy. However, it is often used in the acute setting to assess the degree of coagulopathy in patients with hepatic cirrhosis or acute liver failure. This often influences therapeutic decisions about invasive procedures or the need for potentially harmful and unnecessary transfusions of blood product. This may not represent a best-practice or evidence-based approach to patient care. The author performed a review of the literature related to the utility of INR in cirrhotic patients using several scientific search engines. Despite the commonly accepted dogma that an elevated INR in a cirrhotic patient corresponds with an increased hemorrhagic risk during the performance of invasive procedures, the literature does not support this belief. Furthermore, the need for blood- product transfusion prior to an invasive intervention is not supported by the literature, as this practice increases the risk of complications associated with a patient’s hospital course. Many publications ranging from case studies to meta-analyses refute this evidence and provide examples of thrombotic events despite elevated INR values. Alternative methods, such as thromboelastogram, represent alternate means of assessing in vivo risk of hemorrhage in patients with acute or chronic liver disease in real-time in the acute setting.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "liver"
        },
        {
            "word": "coagulopathy"
        },
        {
            "word": "INR"
        },
        {
            "word": "Trauma"
        },
        {
            "word": "Surgery"
        },
        {
            "word": "Intensive care"
        },
        {
            "word": "bleeding risk"
        }
    ],
    "section": "Resource Utilization",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5hv582jc",
    "frozenauthors": [
        {
            "first_name": "Michael",
            "middle_name": "F.",
            "last_name": "Harrison",
            "name_suffix": "",
            "institution": "Henry Ford Hospital, Department of Emergency Medicine, Department of Internal Medicine, Department of Critical Care Medicine, Detroit, Michigan",
            "department": "None"
        }
    ],
    "date_submitted": "2018-02-09T19:26:36Z",
    "date_accepted": "2018-02-09T19:26:36Z",
    "date_published": "2018-08-08T19:55:27Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11616/galley/6254/download/"
        }
    ]
}