Coagulation in Liver Disease — FRCA Final MCQ

Correct answer: B — Viscoelastic testing provides a more global functional haemostatic profile than the INR alone

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

B is correct. Cirrhosis produces fragile, rebalanced haemostasis because synthesis of both procoagulant factors and endogenous anticoagulants is reduced, with additional changes in platelets, von Willebrand factor and fibrinolysis. INR measures only part of procoagulant clot initiation and does not quantify net haemostasis or reliably predict procedural bleeding. TEG or ROTEM assesses clot initiation, propagation, strength and lysis, providing a more global functional profile, although it cannot reliably predict bleeding in isolation. Prophylactic FFP to reach an arbitrary INR target is not recommended and may increase portal pressure through plasma expansion. A platelet count of 88 × 10⁹/L does not justify transfusion to above 100 × 10⁹/L. Operative suitability requires broader assessment of liver severity, portal hypertension, decompensation and surgical risk rather than exclusion based solely on these tests.

Reference: British Society of Gastroenterology, British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis – part 3: special circumstances, section ‘Management of bleeding risk for invasive procedures’, 2023. https://fg.bmj.com/content/14/6/474