Bleeding risk and thrombosis in cirrhosis:a paradox with a need to address them

作     者：Anand V.Kulkarni K.Rajender Reddy 

作者机构：Department of HepatologyAsian Institute of GastroenterologyHyderabadIndia Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPAUSA 

出 版 物：《Hepatobiliary Surgery and Nutrition》 (肝胆外科与营养（英文）)

年 卷 期：2023年第12卷第3期

页      面：410-412页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Viscoelastic tests international normalized ratio(INR) coagulation liver disease 

摘      要：Patients with cirrhosis have a state of“rebalanced hemostasiswhere there is a simultaneous reduction in both qualitative and quantitative properties of procoagulants and anticoagulants,i.e.,platelets,fibrinogen,coagulation factors,protein C,S,and antithrombin and conversely,there is an increase in the levels of von Willebrand factor,endothelial factor VIII,tissue plasminogen activator(t-PA),and plasminogen activator inhibitor type 1(PAI-1)(1).Laboratory tests,such as INR,involving these coagulation proteins have been used for the prognostication of patients with cirrhosis/liver failure and have historically been part of several severity scores(2,3).Spontaneous bleeding due to clotting factor deficiencies is less frequent in the absence of mechanical trauma,while thrombosis is not uncommon and may merit anticoagulation therapy(4).However,the management of patients with cirrhosis with abnormalities in the hemostasis system is *** meet this unmet need,the European Association for the Study of the Liver(EASL)developed new guidelines for the prevention and management of bleeding and thrombosis in patients with cirrhosis(5).The bleeding here is referred to mucocutaneous and visceral bleeding events.