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Assessment of hemostatic profile in patients with mild to advanced liver cirrhosis

World Journal of Gastroenterology 2020年第17期26卷 2097-2110页

作者： Elisabeth Hannah Adam Madara Mohlmann Eva Herrmann Sonia Schneider Kai Zacharowski Stefan Zeuzem Christian Friedrich Weber Nina Weiler Department of Anaesthesiology Intensive Care Medicine and Pain TherapyUniversity Hospital FrankfurtGoethe-University FrankfurtFrankfurt 60590Germany Department of Biostatistics and mathematical modeling University Hospital FrankfurtGoethe-University FrankfurtFrankfurt 60590Germany Department of Internal Medicine Division of Gastroenterology and HepatologyUniversity Hospital FrankfurtGoethe-University FrankfurtFrankfurt 60590Germany Department of Anaesthesiology Intensive Care Medicine and Emergency MedicineAsklepios Clinics HamburgHamburg 22043Germany

BACKGROUND Hemostasis of patients suffering from liver cirrhosis is challenging due to both,pro-and anticoagulatory disorders leading to hemostatic alterations with distinct abnormalities of *** changes in conventional coagulation analysis and platelet count are common manifestations of decreased liver synthesis of coagulation factors and reduced platelet count in these ***,conventional coagulation analysis and platelet count do not reflect invivo coagulation status or platelet *** purpose of this present observational study was therefore to assess the haemostatic profile including plasmatic coagulation using thrombelastometry and impedance aggregometry for platelet function in patients suffering from liver *** To assess the hemostatic profile of cirrhotic patients according to model for endstage liver disease(MELD)*** Our study included both in-and outpatients suffering from liver cirrhosis attending the out-and inpatient care of the department of *** and biochemical data as well as medical history including cause of liver cirrhosis,end stage kidney failure and medication with anticoagulants were *** assess the hemostatic profile,platelet function was analyzed by multiple electrode aggregometry(MEA)using Multiplate^■(ADP-,ASPI-and TRAP-test)and thrombelastometry using ROTEM^■(EXTEM,INTEM,FIBTEM).Data were compared using Mann-Whitney U-or χ^*** correlation was performed to analyze the association between MELD Score and results of thrombelastometry and *** A total of 68 patients attending the out-and inpatient care suffering from liver cirrhosis were *** these,50 patients were included and assigned to groups according to MELD score 6 to 11(n=25)or≥17(n=25).Baseline patient characteristics revealed significant differences for MELD score(8 vs 22,P<0.0001)and underlying laboratory parameters(international normalized ratio,bilirubine,creatinine)as well as

关键词： Liver cirrhosis Model for end-stage liver disease Coagulopathy Multiple electrode aggregometry thrombelastometry Hemostasis

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Hemostasis in liver transplantation:Pathophysiology,monitoring,and treatment

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World Journal of Gastroenterology 2016年第4期22卷 1541-1550页

作者： Matthias Hartmann Cynthia Szalai Fuat H Saner Klinik für Anaesthesiologie und Intensivmedizin Universitätsklinikum EssenUniversität Duisburg-EssenD-45122 EssenGermany Klinik für Allgemeinchirurgie Viszeralund TransplantationschirurgieUniversitätsklinikum EssenUniversität Duisburg-EssenD-45122 EssenGermany

Recent findings in the pathophysiology and monitoring of hemostasis in patients with end stage liver disease have major impact on coagulation management during liver transplantation. There is increasing evidence, that the changes in both coagulation factors and platelet count regularly observed in patients with liver cirrhosis cannot be interpreted as a reliable indicator of diffuse bleeding risk. Instead, a differentiated view on hemostasis has led to the concept of a rebalanced coagulation system: While it is important to recognize that procoagulant factors are reduced in liver cirrhosis, it is also evident that synthesis of anticoagulant factors and fibrinolytic proteins produced in the liver is also diminished. Similarly, the decreased platelet count may be counterbalanced by increased platelet aggregability caused by highly active von Willebrand multimeres. The coagulation system is therefor stated to be rebalanced. While under normal "unstressed" conditions diffuse bleeding is rarely observed, however both diffuse bleeding or thrombus formation may occur when compensation mechanisms are exhausted. While most patients presenting for liver transplantation have severe cirrhosis, liver function and thus production of pro- and anticoagulant factors can be preserved especially in cholestatic liver disease. During liver transplantation, profound changes in the hemostasis system can occur. Surgical bleeding can lead to diffuse bleeding as coagulation factors and platelets are already reduced. Ischemia and tissue trauma can lead to alterations of hemostasis comparable to trauma induced coagulopathy. A further common disturbance often starting with the reperfusion of the transplanted organ is hyperfibrinolysis which can eventually precipitate complete consumption of fibrinogen and an endogenous heparinization by glycocalyx shedding. Moreover, thrombotic events inliver transplantations are not uncommon and contribute to increased mortality. Besides conventional laborator

关键词： Liver transplantation Hemostasis Bed-sidemonitoring Thrombelastography thrombelastometry Coagulation factors

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