ReviewThe western journal of emergency medicine2018
The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting.
Review in The western journal of emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed.
- Bleeding and Thrombotic Risk in Cirrhosis: Hemostatic Profiles from a Single-Center Experience.Life (Basel, Switzerland) · 2026Article
- Comprehensive review on the current management of upper-GI bleed.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Review
- Integrated routine laboratory indices for risk stratification in HBV-related cirrhosis: a real-world study.BMC gastroenterology · 2026Article
- Interpretable machine learning for early prediction of sepsis-induced coagulopathy: a multicenter retrospective development and validation study.BMC medical informatics and decision making · 2026Article
- Viscoelastic haemostatic assays in chronic liver disease-Profiling coagulation in the emergency department.Vox sanguinis · 2026Article
- Development and external validation of a nomogram to predict prolonged postoperative mechanical ventilation in patients with acute type A aortic dissection.Frontiers in cardiovascular medicine · 2026Article
- Beyond Rebalanced Haemostasis: Haemostatic Phenotypes, Thrombin Generation, and Clinical Risk in Chronic Liver Disease.TH open : companion journal to thrombosis and haemostasis · 2026Review
- Clinical Impact of Viscoelastic Testing in Liver Transplantation: A Before-and-After Study of Transfusion Needs and Outcomes.Journal of clinical medicine · 2025Article
- Yellow Fever in Non-Human Primates: A Veterinary Guide from a One Health Perspective.Veterinary sciences · 2025Review
- Association of Adverse Perinatal Outcomes with Blood Components Transfusion in Patients with Acute Fatty Liver of Pregnancy.International journal of women's health · 2025Article
- A Rare Case of Life-Threatening Hemorrhage.Cureus · 2024Article
- New Pathophysiological Insights from Serum Proteome Profiling in Equine Atypical Myopathy.ACS omega · 2024Article
- Assessment of the efficiency and safety of anti-coagulation therapy in patients with liver cirrhosis and atrial fibrillation.Clinical and experimental hepatology · 2023Article
- Prothrombinex®-VF in chronic liver disease: Friend or foe?Emergency medicine Australasia : EMA · 2023Article
- Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease.Diagnostics (Basel, Switzerland) · 2022Review
- Correcting Coagulopathy for Image-Guided Procedures.Seminars in interventional radiology · 2022Review
- Prognosis and Survival Modelling in Cirrhosis Using Parenclitic Networks.Frontiers in network physiology · 2022Article
- Update on the management of upper gastrointestinal bleeding.BMJ medicine · 2022Review
- The hemostatic and thrombotic complications of liver disease.European journal of haematology · 2021Review
- Multiple organ involvement and ICU considerations for the care of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in children.Translational pediatrics · 2021Review
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.