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The international normalized ratio (INR) sildenafil gel oral for prothrombin times is often abnormal. Electrolyte disturbances including hypokalemia and hypomagnesemia can be present. Platelet counts may be reduced by a direct effect of ethanol on the bone marrow or by splenic sequestration from hypersplenism. Alcoholic cirrhosis can also result in elevation of aminotransferase levels including an AST/ALT ratio of greater than 1. Coagulopathy occurs from impaired hepatic production of coagulation factors.