Hematological Issues in Liver Disease

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Abstract

Patients with liver disease have long been considered at risk for bleeding complications. Although bleeding in patients with cirrhosis occurs frequently on the basis of portal hypertension, evidence accumulated over the last 10 years suggests that the underlying state of hemostasis in patients with cirrhosis and acute liver failure appears to be “re-balanced,” such that redundant mechanisms exist to compensate for deficient pro-coagulant, liver-derived factors. Recent clinical and in vitro research has demonstrated that stable patients with acute and chronic liver failure actually exist in a relative hypercoagulable state, which may propagate the progression of liver disease itself as well as cause systemic thrombotic complications. Surely, treating such patients with blood and blood products has the potential to exacerbate the hypercoagulable state and cause harm. The following will summarize much of the background to the new concept of re-balanced hemostasis in patients with cirrhosis and acute liver failure, and suggest therapeutic options other than repleting blood products to achieve a “goal,” the often unattainable normalization of standard coagulation laboratories.

Keywords

Hemostasis Cirrhosis Acute liver failure Bleeding Thrombosis Coagulopathy 

Abbreviations

ACLF

acute-on-chronic liver failure

ADAMTS-13

a disintegrin and metalloprotease with thrombospondin type-1 motifs 13

ALF

acute liver failure

AT

antithrombin

HCC

hepatocellular carcinoma

ICP

intracranial monitor

INR

International Normalized Ratio of the prothrombin time

LMWH

low molecular weight heparin

MOSF

multiorgan system failure

NASH

non-alcoholic steatohepatitis

PS

phosphatidylserine

PVT

portal vein thrombosis

RBC

red blood cells

rFVIIa

recombinant activated factor VII

RRT

renal replacement therapy

SIRS

systemic inflammatory response syndrome

SMV

superior mesenteric vein

TEG

thromboelastography

TF

tissue factor

TM

thrombomodulin

VTE

venous thromboembolism

vWF

vonWillebrand factor

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Hume-Lee Transplant Center of Virginia Commonwealth UniversityRichmondUSA

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