Conjugated Estrogen for Platelet Dysfunction Associated with Liver Disease

To the Editor: Livio et al. (Sept. 18, 1986, issue)¹ demonstrated the beneficial effect of conjugated-estrogen therapy in reversing platelet dysfunction in patients with uremia. The authors concluded that conjugated estrogens are an adequate alternative to cryoprecipitate or desmopressin in this clinical setting. The mechanism of action remains unclear, since in contrast to cryoprecipitate and desmopressin, estrogen does not appear to increase the circulating level or change the multimeric structure of von Willebrand factor. In a fashion similar to that of patients with uremia, patients with liver disease may have a hemostatic defect related to platelet dysfunction. Desmopressin has been.