Coagulation Assessment Before Epidural in Liver Disease — FRCA Final MCQ

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ModerateRegional AnaesthesiaCoagulation Assessment Before Epidural in Liver DiseaseFRCA Final

A 58-year-old man (ASA III) with chronic liver disease has a prolonged PT and low albumin. He requires an epidural for major abdominal surgery. What specific coagulation parameter is most important to check before epidural insertion?

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Correct answer: D — Platelet count AND fibrinogen level in addition to PT/INR

In chronic liver disease, standard coagulation tests (PT/INR) may overestimate bleeding risk because they only measure procoagulant factors. However, for the specific purpose of neuraxial blockade safety, the most important parameters to check are: (1) platelet count – should be >80 × 10⁹/L for epidural (some guidelines say >75), (2) fibrinogen level – should be >1.0 g/L (ideally >2.0), and (3) PT/INR as a baseline (though unreliable in isolation). Viscoelastic testing (TEG/ROTEM) provides a more global assessment of haemostatic function if available and should be considered in liver disease.

Reference: Association of Anaesthetists – 2013 – Regional anaesthesia and coagulation; BSH – 2020 – Coagulation in liver disease