AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

O’Shea, Robert; Ko, Cynthia W.; Rajasekhar, Anita; Su, Grace L.; Sultan, Shahnaz; Allen, Alina M.; Falck‐Ytter, Yngve

doi:10.1053/j.gastro.2021.08.015

Cited by 61 publications

(88 citation statements)

References 76 publications

(67 reference statements)

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“…Platelet count thresholds are often stipulated for invasive procedures in patients with severe thrombocytopenia related to cirrhosis. Although a specific platelet count cut‐off, below which platelet‐raising treatments is recommended by many international guidelines, there is no firm evidence for this practice 3,4 . From a laboratory perspective, in vitro data suggested a platelet count threshold of 55 × 10 9 /L to be necessary for adequate platelet procoagulant function, but the study did not evaluate the platelet function related to primary hemostasis (i.e., adhesiveness and aggregation) 34 .…”

Section: Procedural Bleeding Risk In Patients With Cirrhosismentioning

confidence: 98%

“…Although a specific platelet count cut-off, below which platelet-raising treatments is recommended by many international guidelines, there is no firm evidence for this practice. 3,4 From a laboratory perspective, in vitro data suggested a platelet count threshold of 55 × 10 9 /L to be necessary for adequate platelet procoagulant function, but the study did not evaluate the platelet function related to primary hemostasis (i.e., adhesiveness and aggregation). 34 In an analysis of the in vivo relevance of these in vitro findings, it was noted that 26 patients with cirrhosis who required variceal banding, transfusion of one adult dose of platelets, despite increasing the count, did not have a significant effect on thrombin generation while the minor increment in the platelet count reflected only a small improvement in thromboelastometry markers.…”

Section: Ta B L Ementioning

confidence: 99%

“…In addition to recognition of rebalanced hemostasis, awareness of the low bleeding risk associated with common procedures performed in patients with cirrhosis is essential. Contemporary international hepatology/gastroenterology guidance now recommends against empirical correction of prolonged coagulation times and/or thrombocytopenia 3,4 . In this guidance document, we summarize the periprocedural bleeding risk for common elective procedures performed in patients with cirrhosis, discuss the risk factors for bleeding, evaluate the benefits and potential risk of attempting to correct thrombocytopenia, prolonged PT, hypofibrinogenemia, and the agents available (summarized in Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…against empirical correction of prolonged coagulation times and/ or thrombocytopenia. 3,4 In this guidance document, we summarize the periprocedural bleeding risk for common elective procedures performed in patients with cirrhosis, discuss the risk factors for bleeding, evaluate the benefits and potential risk of attempting to correct thrombocytopenia, prolonged PT, hypofibrinogenemia, and the agents available (summarized in Figure 1).…”

mentioning

confidence: 99%

See 3 more Smart Citations

Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH

Roberts

Lisman

Stanworth

et al. 2022

Journal of Thrombosis and Haemostasis

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Prolonged prothrombin time and thrombocytopenia are common in patients with cirrhosis. These parameters do not reflect the overall hemostatic rebalance or bleeding risk in the periprocedural setting; however, attempts to correct these parameters remain frequent. We review the literature on periprocedural bleeding risk, bleeding risk factors, and the risk and benefits of hemostatic interventions in patients with cirrhosis. We provide guidance recommendations on evaluating bleeding risk in this patient group and management of hemostatic abnormalities in the periprocedural setting.

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Section: Procedural Bleeding Risk In Patients With Cirrhosismentioning

confidence: 98%

Section: Ta B L Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH

Roberts

Lisman

Stanworth

et al. 2022

Journal of Thrombosis and Haemostasis

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“…Chronic liver diseases are often associated with portal vein thrombosis (PVT), and anticoagulation is a standard of care for treating PVT. Thus, studies have assessed the pharmacological safety of anticoagulants in patients with advanced chronic liver diseases ( 45 – 47 ).…”

Section: Coagulation Factors In Organ Fibrosismentioning

confidence: 99%

The Therapeutic Potential of Anticoagulation in Organ Fibrosis

Park

Song

et al. 2022

Front. Med.

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Fibrosis, also known as organ scarring, describes a pathological stiffening of organs or tissues caused by increased synthesis of extracellular matrix (ECM) components. In the past decades, mounting evidence has accumulated showing that the coagulation cascade is directly associated with fibrotic development. Recent findings suggest that, under inflammatory conditions, various cell types (e.g., immune cells) participate in the coagulation process causing pathological outcomes, including fibrosis. These findings highlighted the potential of anticoagulation therapy as a strategy in organ fibrosis. Indeed, preclinical and clinical studies demonstrated that the inhibition of blood coagulation is a potential intervention for the treatment of fibrosis across all major organs (e.g., lung, liver, heart, and kidney). In this review, we aim to summarize our current knowledge on the impact of components of coagulation cascade on fibrosis of various organs and provide an update on the current development of anticoagulation therapy for fibrosis.

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Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care

Pillai

Kriss

Al‐Adra

et al. 2022

Liver Transplantation

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Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies Anjana A. Pillai and Michael Kriss contributed equally to this study and share co-first authorship.Constantine J. Karvellas and Nicolas Intagliata contributed equally to this study and share co-senior authorship.

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AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

Cited by 61 publications

References 76 publications

Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH

Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH

The Therapeutic Potential of Anticoagulation in Organ Fibrosis

Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care

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