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. 2017 May;3(3):10.15761/JTS.1000182.
doi: 10.15761/JTS.1000182. Epub 2017 Mar 4.

Hemostasis, bleeding and thrombosis in liver disease

Brisas Flores  1 , Hirsh D Trivedi  2 , Simon C Robson  2 , Alan Bonder  2
Affiliations

Hemostasis, bleeding and thrombosis in liver disease

Brisas Flores et al. J Transl Sci. 2017 May.

Abstract

The presence of cirrhosis poses an increased risk of both thrombosis and bleeding in individuals with chronic liver disease. This duality is a result of a dynamic disequilibrium between procoagulant and anticoagulant states in individuals with cirrhosis. The mechanism of this imbalance in cirrhosis remains unclear. It is known that the progression of cirrhosis leads to decreased synthetic function and a concurrent lack of natural anticoagulants. Other proposed mechanisms contributing to this hemostatic imbalance include decreased platelet production, increased platelet destruction from hypersplenism, decreased synthesis of Vitamin K-dependent and independent clotting factors and anticoagulant factors, and alterations in purinergic signaling pathways. Given the current state of flux in our understanding of bleeding and thrombophilia in cirrhosis, the recommendations for treatment of these conditions are still evolving. We provide a current update on the proposed pathophysiology of altered hemostasis and thrombophilia in cirrhosis. We discuss recent studies in portal vein thrombosis (PVT) and venous thromboembolism (VTE), which are the common thrombotic consequences of cirrhosis, resulting in substantive morbidity and mortality. To address these, we discuss new prophylactic interventions and current treatment options to manage the heightened risk of thrombosis in cirrhosis, while limiting hemorrhagic complications.

Keywords: anticoagulation; bleeding; cirrhosis; hemorrhage; liver disease; thrombosis.

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Figures

Figure 1
Figure 1
Review of coagulation cascade and the associated pathophysiologic changes that occur with cirrhosis [,–17]. The green arrow denotes products are increased, whereas the red arrow denotes products are decreased.
Figure 2
Figure 2
Recommended algorithm for treatment of acute portal vein thrombosis. *TIPS only to be employed if other indications for TIPS present.
Figure 3
Figure 3
Recommended algorithm for treatment of chronic portal vein thrombosis. *TIPS only to be employed if other indications for TIPS present.
See this image and copyright information in PMC

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