Coagulopathy in fulminant liver failure with ultimately fatal clot formation

Excerpt

A 57-year-old man with known liver cirrhosis was admitted to the emergency department because of malaise. On admission the patient was jaundiced and with chronic liver failure stigmata. Clinical examinations revealed encephalopathy grade 2. Laboratory results showed severe liver enzyme derangement with prolonged coagulation times (INR 6.2) and low platelet count (23,000). The patient progressed to severe encephalopathy that required intubation and mechanical ventilation and established multi-organ failure with anuria. Because of his potential inclusion on the transplant list, aggressive management was provided. A CT scan was done to diagnose a potential acute portal thrombosis, and the findings revealed a long and severely occlusive clot that originated in the inferior cava vein (IVC) up to the right ventricle (Fig. 1). In addition, there was a confirmed portal vein thrombosis. The patient progressed to refractory multi-organ failure and died.

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