Hemostasis and thrombosis in patients with liver disease: the ups and downs.

Patients with chronic or acute liver failure frequently show profound abnormalities in their hemostatic system. Whereas routine laboratory tests of hemostasis suggest these hemostatic alterations result in a bleeding diathesis, accumulating evidence from both clinical and laboratory studies suggest that the situation is more complex. The average patient with liver failure may be in hemostatic balance despite prolonged routine coagulation tests, since both pro- and antihemostatic factors are affected, the latter of which are not well reflected in routine coagulation testing. However, this balance may easily tip towards a hypo- or hypercoagulable situation. Indeed, patients with liver disease may encounter both hemostasis-related bleeding episodes as well as thrombotic events. During the 3rd International Symposium on Coagulopathy and Liver disease, held in Groningen, The Netherlands (18-19 September 2009), a multidisciplinary panel of experts critically reviewed the current data concerning pathophysiology and clinical consequences of hemostatic disorders in patients with liver disease. Highlights of this symposium are summarized in this review.

Lisman T ，Caldwell SH ，Burroughs AK ，Northup PG ，Senzolo M ，Stravitz RT ，Tripodi A ，Trotter JF ，Valla DC ，Porte RJ ，Coagulation in Liver Disease Study Group ... -  《-》

Rebalanced hemostasis in liver disease: a misunderstood coagulopathy.

The combination of frequently abnormal hemostatic markers and catastrophic bleeding as seen with variceal hemorrhage has contributed to the longstanding misperception that chronic liver disease (CLD) constitutes a bleeding diathesis. Laboratory studies of hemostasis in liver disease consistently challenge this with global coagulation assays incorporating activation of the protein C pathway demonstrating rebalanced hemostasis. It is now recognized that bleeding in CLD is predominantly secondary to portal hypertension (rather than a coagulopathy) and additionally that these patients are at increased risk of venous thrombosis, particularly in the portal venous system. This narrative review describes the current understanding of hemostasis in liver disease, as well as the periprocedural management of hemostasis and anticoagulation for management of venous thromboembolism in patients with CLD.

Roberts LN 《-》

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences.

Lisman T ，Porte RJ 《-》

Hemostatic alterations in liver disease: a review on pathophysiology, clinical consequences, and treatment.

Lisman T ，Leebeek FW 《DIGESTIVE SURGERY》

Coagulation and fibrinolysis in individuals with advanced liver disease.

Van Thiel DH ，George M ，Mindikoğlu AL ，Baluch MH ，Dhillon S ... -  《Turkish Journal of Gastroenterology》