During the 7-year period January 1987 to December 1993, 560 patients with paracetamol-induced severe hepatotoxicity were treated in the Liver Failure Unit of King’s College Hospital (KCH). All the patients, when transferred to KCH, had a significant coagulo pathy (an International Normalized Ratio (INR) of >5 at any time post overdose or an INR >2 at 24 h, >4 at 48 h or >6 at 72 h post overdose with or without evidence of a metabolic acidosis, renal failure and encephalopathy.