[Hepatic coagulopathy--principles and therapeutic statements].

In liver parenchymatous disease there is a significant correlation between plasma concentrations of coagulation factors of the prothrombin complex and antithrombin III on the one hand and the severity of the disease on the other hand. These coagulation factors are suitable for following the course of the disease because of their short biological half time. In liver failure hepatic clearance of activated coagulation factors may be delayed which will have influences upon the hemostatic mechanisms. An increased disposition for disseminated intravasal coagulation thus exists in infections, hemorrhagic shock and during monotherapy with concentrated prothrombin complex. Therapy with blood or plasma and its derivatives should always be directed at keeping an equilibrium between activating and inhibiting coagulation factors. Fresh plasma, fractionated blood exchange, or a combined application of equivalent units of antithrombin III and prothrombin complex concentrate with minimal heparin doses are suited for such therapy.