When acute hepatitis C is accompanied by coagulopathy (INR >1.5) or overt signs of acute liver failure — such as hepatic encephalopathy — the clinical picture demands immediate escalation beyond standard outpatient HCV management.
This protocol applies to patients with acute hepatitis C who present with an INR >1.5 or who exhibit any signs of acute liver failure, including hepatic encephalopathy. Either finding marks a threshold that fundamentally changes the urgency and setting of care.
Immediate referral to a specialist centre is the central action in this scenario. Decisions about HCV antiviral therapy in the setting of acute liver failure require involvement of a clinician with specific HCV treatment experience — the complete structured protocol is accessible below.