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INR Correction in Liver Disease — FRCA Final MCQ

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HardPerioperative MedicineINR Correction in Liver DiseaseFRCA Final

A 55-year-old man with decompensated alcohol-related cirrhosis requires ultrasound-guided therapeutic paracentesis. His INR is 2.1 and platelet count is 62 × 10^9/L. He is not taking an anticoagulant and has no active bleeding, sepsis, acute kidney injury or evidence of disseminated intravascular coagulation. Which is the most appropriate haemostatic management before the procedure?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Proceed without prophylactic FFP, PCC or platelet transfusion

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

C is correct. Therapeutic paracentesis is a low-bleeding-risk procedure, and UK BSG/BASL guidance advises against prophylactic blood products based on INR or platelet count. Cirrhosis reduces both procoagulant factors and natural anticoagulants, producing a fragile rebalanced haemostatic state that INR does not measure adequately. FFP may produce little meaningful improvement in haemostasis and can cause circulatory overload and increase portal pressure. A platelet count of 62 × 10^9/L does not justify transfusion, particularly not to an arbitrary target of 100 × 10^9/L. Vitamin K is appropriate only where deficiency is suspected, or for vitamin K antagonist reversal. PCC is not indicated simply to normalise the INR in a non-bleeding patient with cirrhosis.

Reference: British Society of Gastroenterology and British Association for the Study of the Liver. Guidelines on the management of ascites in cirrhosis, section 5.3, 2021. https://gut.bmj.com/content/70/1/9