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Role of anticoagulant therapy in liver disease

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Abstract

Anticoagulant therapy is a cornerstone in the treatment of different liver diseases. In Budd-Chiari syndrome (BCS), survival rates have increased considerably since the introduction of a treatment strategy in which anticoagulation is the treatment of first choice. In all patients diagnosed with acute portal vein thrombosis (PVT), anticoagulant therapy for at least 3 months is indicated. Anticoagulation should also be considered in patients with chronic PVT and a concurrent prothrombotic risk factor. Current evidence suggests that patients with PVT in cirrhosis will benefit from treatment with anticoagulation as well. In severe chronic liver disease the levels of both pro- and anticoagulant factors are decreased, resetting the coagulant balance in an individual patient and making it more prone to deviate to a hypo- or hypercoagulable state. An increased activity of the coagulation cascade is not solely a feature of chronic liver disease; it influences the development of liver fibrosis as well. Several studies in animals and humans have shown that anticoagulation could prevent or improve fibrogenesis and even disease progression in cirrhosis. Anticoagulation is therefore a promising antifibrotic treatment modality.

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Abbreviations

APTT:

Activated partial thromboplastin time

BCS:

Budd-Chiari syndrome

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

HSC:

Hepatic stellate cells

INCPH:

Idiopathic noncirrhotic portal hypertension

INR:

International normalised ratio

LMWH:

Low-molecular-weight heparin

PAR:

Protease-activated receptor

PT:

Prothrombin time

PVT:

Portal vein thrombosis

SOS:

Sinusoidal obstruction syndrome

TIPS:

Transjugular intrahepatic portosystemic shunt

VKA:

Vitamin K antagonists

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  1. Department of Gastroenterology and Hepatology, Erasmus Medical Center, ‘s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Elisabeth P. C. Plompen, Jeoffrey N. L. Schouten & Harry L. A. Janssen

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  1. Elisabeth P. C. Plompen
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  2. Jeoffrey N. L. Schouten
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  3. Harry L. A. Janssen
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Correspondence to Harry L. A. Janssen.

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Plompen, E.P.C., Schouten, J.N.L. & Janssen, H.L.A. Role of anticoagulant therapy in liver disease. Hepatol Int 7, 369–376 (2013). https://doi.org/10.1007/s12072-013-9427-2

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