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Review
. 2022 Apr 3;14(4):e23785.
doi: 10.7759/cureus.23785. eCollection 2022 Apr.

Cirrhosis and Coagulopathy: Mechanisms of Hemostasis Changes in Liver Failure and Their Management

Rabia Islam  1 , Sumana Kundu  2 , Surajkumar B Jha  3 , Ana P Rivera  4 , Gabriela Vanessa Flores Monar  5 , Hamza Islam  1 , Sri Madhurima Puttagunta  6 , Ibrahim Sange  7
Affiliations
Review

Cirrhosis and Coagulopathy: Mechanisms of Hemostasis Changes in Liver Failure and Their Management

Rabia Islam et al. Cureus. .

Abstract

Cirrhosis is an end-stage liver disease that can cause changes in any component of the hemostatic system. The net effects of the complicated hemostatic changes have long been unknown due to concurrent changes in pro-and antihemostatic drivers. Coagulation disorders are caused by various factors, including decreased clotting and inhibitor factor synthesis, reduced clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis, and increased intravascular coagulation. This review discusses the pathogenesis of coagulopathy and multiple studies related to its clinical presentations. This article also highlights an additional problem in the diagnostic and therapeutic approach to this group of patients: the fact that traditional coagulation tests and transfusional strategies may not be reliable for assessing and managing bleeding or thrombotic risks. Hence, multiple management options have been assessed for bleeding and thrombosis in liver disease.

Keywords: antifibrinolytics; blood coagulation factors; cirrhosis; deep vein thrombosis (dvt); direct acting oral anticoagulant; gastrointestinal hemorrhage; hemeostatic system; portal vein thrombosis; thrombocytopenia; venous thromboembolism (vte).

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Conflict of interest statement

Dr. Ibrahim Sange, who is the final author of the paper, contributed to writing the abstract and serves as a mentor in writing. He was also consulted on the editing and proofreading of the manuscript. For his services, a basic fee was paid to him.

Figures

Figure 1
Figure 1. Changes in the coagulation and fibrinolytic system in liver disease
vWF: von Willebrand factor; tPA: tissue plasminogen activator
Figure 2
Figure 2. Trends of prohemostatic and antihemostatic drivers in the different phases of hemostasis in chronic liver disease patients
ADAMTS 13 denotes disintegrin and metalloprotease with thrombospondin type 1 motif 13 PAI: plasminogen activator inhibitor; TAFI: thrombin-activatable fibrinolysis inhibitor; tPA: tissue plasminogen activator
See this image and copyright information in PMC

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