A Misguided Contraindication: International Normalized Ratio in Acute Liver Failure Precluding Thrombolysis for Massive Pulmonary Embolism. Issue 4 (15th February 2019)

• Record Type: Journal Article
• Authors: Long, Micah T.; Gallo, Paul D.; Hammel, Laura L.; Coursin, Douglas B.
• Is Part Of: A & A practice. Volume 12:Issue 4(2019)
• Publication Date: 2019-02-15
• Subjects: Analgesia -- Periodicals; Analgesia -- Case studies -- Periodicals; Anesthesiology -- Periodicals; Anesthesiology -- Case studies -- Periodicals; 617.9605
• DOI: 10.1213/XAA.0000000000000856
• Languages: English
• ISSNs: 2575-3126

Abstract

Abstract : Massive pulmonary embolism and its treatment with thrombolysis both carry grave risks. Optimal management hinges on determining the risk-to-benefit ratio of thrombolytic administration. For patients with liver dysfunction, assessing bleeding risk is challenging because they may have elevations in the international normalized ratio yet be hypercoagulable. We describe a patient with massive pulmonary embolism and new-onset liver failure, who—absent contraindications—warranted thrombolysis. Initial laboratory values, however, revealed an elevated international normalized ratio, which precluded lysis, despite a hypercoagulable Thromboelastogram. We believe that viscoelastic testing of coagulation is essential for evaluating coagulation in liver dysfunction, particularly when considering thrombolysis.