Liver disease associated coagulopathy

Liver disease associated coagulopathy
Updated: 07/29/2025
© Jun Wang, MD, PhD

General features
  • Commonly associated with chronic liver disease, including alcoholic liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis, other causes of liver injury by toxin, drug, genetic abnormalities, or autoimmune disorders
  • Multiple factor deficiency due to impaired production in liver
  • Vitamin K deficiency may exacerbate deficiency of VK associated factors (II, VII, IX, X)
  • Two factors not affected by abnormal liver function
Factor VIII produced by endothelial cells
Factor XIII, produced in bone marrow
Clinical presentations
  • Bleeding
  • Thrombosis: Decreased plasminogen, protein C and protein S
  • Presentations associated with underline liver diseases, such as esophageal varices
Key pathogenesis
  • Impaired production of coagulation factors
Key Laboratory findings
  • Prolongations of aPTT, PT, INR
  • Mild thrombocytopenia
  • Elevated D-dimer
  • Normal level of factor VIII
Differential diagnosis
  • TTP: Clinical setting, normal PT and PTT, low ADAMTS13
  • HIT: History of heparin usage, normal PT, aPTT and fibrinogen, antibodies against PF4
  • DIC: Usually reduced levels of factor VIII


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