American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is a key characteristic of coagulopathy due to liver disease?

1. Increased prothrombin time

2. High factor VIII levels

3. High levels of all clotting factors

4. Improved bleeding time

The correct answer is: High factor VIII levels

Coagulopathy due to liver disease is primarily characterized by an increased prothrombin time. This occurs because the liver is responsible for producing most of the clotting factors, and liver dysfunction leads to a decrease in the production of these factors, particularly factors II, V, VII, and X, which are essential for the coagulation cascade. In addition, while it's true that factor VIII can be elevated in certain liver diseases, this is not a typical characteristic of coagulopathy associated with liver dysfunction. Generally, patients with liver disease experience an overall decrease in clotting factors, not an increase. Therefore, the presence of elevated factor VIII alone does not define the coagulopathy seen in liver disease. Thus, the hallmark of coagulopathy in the context of liver disease is the prolonged prothrombin time due to the reduction of clotting factors, which reflects the liver's impaired synthetic function. This understanding is crucial for assessing bleeding risks in patients with liver pathology, guiding both management and treatment.