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Management of Acute Coronary Syndrome in Patients with Liver Cirrhosis

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Abstract

Liver cirrhosis (LC) is becoming increasingly common among patients presenting with acute coronary syndromes (ACS) and is associated with significant cardiovascular morbidity and mortality. Management of such patients is complicated by LC related complications. Literature is scarce on the safety of antithrombotic regimens and invasive strategies for ACS in patients with LC, especially those undergoing liver transplant evaluation. Recently there has been evidence that cirrhosis is an independent risk factor for adverse outcomes in ACS. As patients with LC are generally excluded from large randomized trials, definitive guidelines for the management of ACS in this particular cohort are lacking. Many antithrombotic drugs require either hepatic activation or clearance; hence, an accurate assessment of hepatic function is required prior to initiation and dose adjustment. Despite a demonstrated survival benefit of optimal medical therapy and invasive revascularization techniques in LC patients with ACS, both strategies are currently underutilized in this population. This review aims to present currently available data and provide a practical, clinically oriented approach for the management of ACS in LC. Randomized clinical trials in LC patients with ACS are the need of the hour to further refine their management for favorable outcomes.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA

    Taha Ahmed

  2. Department of Gastroenterology and Hepatology, University of Kentucky College of Medicine, Lexington, KY, USA

    Alla Y. Grigorian

  3. Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky College of Medicine, CTW Building, Suite 326, 900 South Limestone, Lexington, KY, 40536, USA

    Adrian W. Messerli

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  1. Taha Ahmed
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  2. Alla Y. Grigorian
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Correspondence to Adrian W. Messerli.

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Ahmed, T., Grigorian, A.Y. & Messerli, A.W. Management of Acute Coronary Syndrome in Patients with Liver Cirrhosis. Am J Cardiovasc Drugs 22, 55–67 (2022). https://doi.org/10.1007/s40256-021-00478-6

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