The liver produces most of the factors involved in coagulation and fibrinolysis that helps maintain the balance between thrombin deposition and removal.38 Patients with cirrhosis frequently experience hemostatic disorders caused by abnormalities of platelet number and/or function, increased fibrinolysis, and deficient synthesis of clotting factors.38 Clotting factor deficiencies develop with the loss of functioning liver paranchymal cells, with early deficits in the Vitamin KĀdependent factors (II, VII, IX, X, protein S, and protein C).38 The loss of factor VII significantly interferes with the function of the extrinsic coagulation cascade.38 Hemorrhagic complication is a major concern in patients with cirrhosis undergoing surgical interventions39 and must be considered when preparing a patient with burn injury with preexisting liver disease for surgery.
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