Enoxaparin Prevents Portal Vein Thrombosis and Liver Decompensation in Patients With Advanced Cirrhosis

Villa, Erica; Cammà, Calogero; Marietta, Marco; Luongo, Monica; Critelli, Rosina Maria; Colopi, Stefano; Tata, C.; Zecchini, Ramona; Gitto, Stefano; Petta, Salvatore; Lei, Barbara; Bernabucci, Veronica; Vukotic, Ranka; Maria, Nicola De; Schepis, Filippo; Karampatou, Aimilia; Caporali, Cristian; Simoni, L; Buono, Mariagrazia Del; Zambotto, Beatrice; Turola, Elena; Fornaciari, Giovanni; Schianchi, Susanna; Ferrari, Anna; Valla, Dominique

doi:10.1053/j.gastro.2012.07.018

Cited by 644 publications

(584 citation statements)

References 30 publications

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“…A recent study found that prevention of PVT with low molecular weight heparin significantly decreased development of PVT and reduced episodes of decompensation. 2 Compared with daily injections, we agree with the authors in that these "nontraditional" oral agents represent an attractive option for cirrhosis patients due to ease of administration. However, we would like to emphasize recent reports advancing a more cautionary tone concerning in vitro efficacy and safety of these medications.…”

Section: Treating Thrombosis In Cirrhosis Patients With New Oral Agensupporting

confidence: 81%

Treating thrombosis in cirrhosis patients with new oral agents: Ready or not?

2014

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Section: Treating Thrombosis In Cirrhosis Patients With New Oral Agensupporting

confidence: 81%

Treating thrombosis in cirrhosis patients with new oral agents: Ready or not?

2014

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“…The value of preventing PVT by the administration of anticoagulants in patients with cirrhosis has been established: in a controlled trial a 12-month course of enoxaparin was safe; in addition, no bleeding occurred in treated or untreated patients [48]. Although encouraging, these preliminary results need confirmation in further studies.…”

Section: Anti-coagulation For the Prevention/treatment Of Portal Veinmentioning

confidence: 98%

“…An in vitro study also suggested that, despite of a lower anti-thrombin level, plasma from patients with cirrhosis was more responsive to LMWH than that from healthy subjects [47]. The only available randomized trial showed that LMWH at a fixed dose and without laboratory monitoring was effective and safe in preventing PVT in patients with cirrhosis [48].…”

Section: Low Molecular Weight Heparin (Lmwh)mentioning

confidence: 99%

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Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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“…In regards to the paradigm of patients with liver disease being at a heightened risk of bleeding, several studies refute this concept by identifying significant development of venous thrombosis in these patients [17,18]. In the same shift of concept, liver transplant patients were paradoxically found to have a procoagulant state in the setting of an elevated INR, as well as lower rates of portal vein thrombosis and improved survival without the development of hemorrhagic complications in patients with decompensated liver disease treated with enoxaparin [19,20].…”

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K. The effectiveness of these treatments is estimated by international normalized ratio (INR), an imprecise measure of coagulation in the setting of cirrhosis. Transfusion with FFP may lead to detrimental side effects, including worsening volume overload and increased portal hypertension. We present a case of a 60-year-old patient intubated for acute hypoxic respiratory failure secondary to volume overload who subsequently developed bilateral pneumothoraces, requiring immediate chest tube placement. In this case, the patient had ongoing hepatic decompensation with volume overload and acute worsening of coagulopathy with an INR of 4.2. In this setting, 4-Factor Prothrombin Complex Concentrate (4F-PCC) was chosen to correct coagulation parameters with a low infusion volume. One hour following administration, INR was 1.5. Chest tubes were placed bilaterally and oxygenation improved without bleeding complications. While the data is still lacking, 4F-PCC may be considered for urgent and emergency situations in cirrhotic patients.

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Enoxaparin Prevents Portal Vein Thrombosis and Liver Decompensation in Patients With Advanced Cirrhosis

Cited by 644 publications

References 30 publications

Treating thrombosis in cirrhosis patients with new oral agents: Ready or not?

Treating thrombosis in cirrhosis patients with new oral agents: Ready or not?

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

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