Liječnički vjesnik, Vol. 138 No. 9-10, 2016.
Review article
ABNORMALITIES OF HEMOSTASIS IN PATIENTS WITH LIVER CIRRHOSIS
Matea Majerović
Ana Boban
Marina Premužić
Davor Radić
Ivana Knežević-Štromar
Agata Ladić
Željko Krznarić
Nadan Rustemović
Rajko Ostojić
Abstract
Until the beginning of the 90ies, it was believed that patients with liver cirrhosis were auto-anticoagulated and thus protected from thromboembolic events. However, new discoveries have broken the longstanding paradigm. In deranged hepatic function there is a reduced synthesis of procoagulants and endogenous anticoagulants, however, extrahepatally synthesized hemostatic and fibrinolytic factors are disproportionately affected. In stable disease hemostatic system is ”rebalanced’’ but fragile, therefore, even a minimal stress can promote bleeding or thrombosis. Also, there are many concomitant factors, such as hemodynamic changes, other organ affection, namely kidney, and predisposition to infection, that shift the balance towards either bleeding or thrombosis. Conventional laboratory tests are not sufficient for evaluation of the bleeding risk, prothrombotic risk factors are not clearly identified, and safety profile of antithrombotic drugs is not precisely evaluated since cirrhotic patients are mainly excluded from big clinical trials. For all that is said, the diagnostic and therapeutic approach in this context is complex and requires teamwork of a hepatologist, hematologist and in a phase of operative treatment, the anesthesiologist. In this review article, we will discuss mechanisms of hemostatic and fibrinolytic abnormalities of liver cirrhosis, the incidence of thromboembolic events as well as prophylactic and therapeutic options in the setting of conservative treatment.
Keywords
Liver cirrhosis – blood, complications, physiopathology, drug therapy; Blood coagulation disorders – etiology, diagnosis, complications, drug therapy; Blood coagulation tests – methods; Hemostasis; Fibrinolysis; Venous thromboembolism – etiology, drug therapy, prevention and control; Hemorrhage – etiology, prevention and control; Anticoagulants – therapeutic use, adverse effects; Blood component transfusion
Hrčak ID:
172890
URI
Publication date:
2.11.2016.
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