Haemostatic alterations and management of haemostasis in patients with cirrhosis

Lisman, Ton; Caldwell, Stephen H.; Intagliata, Nicolas M.

doi:10.1016/j.jhep.2021.11.004

Cited by 51 publications

(72 citation statements)

References 138 publications

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“…For a long time, patients with cirrhosis were considered to be ‘auto‐anticoagulated’ given a reduced platelet function, anticoagulant changes in the coagulation cascade, and a clinical bleeding tendency 71 . The currently accepted view is that the hemostatic system in patients with cirrhosis has been reset back to a rebalanced state 72,73 . This is because routine laboratory tests can only measure the anticoagulant influences, such as prothrombin time and low clotting factors, which are upregulated in cirrhosis 74 .…”

Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

“…The opposing procoagulant influences cannot be easily measured. However, when carefully examined it is clear that procoagulant systems are also upregulated such that the hemostatic balance is restored in cirrhosis 72,73 . Therefore, the increased bleeding complications in cirrhosis are not due to defective haemostasis but structural lesions with increased bleeding tendency, such as varices and portal hypertensive gastropathy.…”

Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

“…71 The currently accepted view is that the hemostatic system in patients with cirrhosis has been reset back to a rebalanced state. 72,73 This is because routine laboratory tests can only measure the anticoagulant influences, such as prothrombin time and low clotting factors, which are upregulated in cirrhosis. 74 The opposing procoagulant influences cannot be easily measured.…”

Section: Oral Anticoagulationmentioning

confidence: 99%

“…However, when carefully examined it is clear that procoagulant systems are also upregulated such that the hemostatic balance is restored in cirrhosis. 72,73 Therefore, the increased bleeding complications in cirrhosis are not due to defective haemostasis but structural lesions with increased bleeding tendency, such as varices and portal hypertensive gastropathy. This is the likely reason for low anticoagulation prescription rates in patients with AF and cirrhosis, ranging between 9.6% and 28.1% in registries.…”

Section: Oral Anticoagulationmentioning

confidence: 99%

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Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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Summary Background Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. Aims To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. Methods An extensive literature search was performed using the terms ‘atrial fibrillation’ and ‘cirrhosis’. Guideline documents and consensus statements were explored. Results The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new‐onset AF in the post‐operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre‐transplant and post‐transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. Conclusions Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.

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Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

Section: Oral Anticoagulationmentioning

confidence: 99%

Section: Oral Anticoagulationmentioning

confidence: 99%

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Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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“…[4][5][6] This is followed by a discussion on the management of advanced liver disease, ranging from coagulation issues, through use of albumin, to liver transplantation and management of hepatocellular carcinoma. [7][8][9][10][11] One article describes the use of non-invasive tests in hepatology practice and the road ahead. 12 Finally, accumulating data have highlighted the importance of molecular biology and the gut microbiome in the diagnosis and treatment of various liver diseases.…”

mentioning

confidence: 99%

Breakthroughs in hepatology

Terrault

Dufour

Schwabe

et al. 2022

Journal of Hepatology

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Portal vein thrombosis in liver cirrhosis: An updated overview

Xiao

Wang

2023

Portal Hypertension & Cirrhosis

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Portal vein thrombosis (PVT) is a frequent and severe complication in patients with cirrhosis; however, the pathophysiology of PVT needs to be better clarified. There are few significant predictive factors in clinical practice, and the impact of PVT on cirrhosis progression and its complications, such as gastrointestinal bleeding, hepatic encephalopathy, and hepatorenal syndrome, remains uncertain. In recent years, the understanding of the mechanisms of PVT has become more profound with the publication of related literature. Therefore, in this review, we aim to summarize the advanced progress in the epidemiology, hazards, risk factors, diagnosis and classification, and treatment of PVT to provide insight into clinical management.

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Haemostatic alterations and management of haemostasis in patients with cirrhosis

Cited by 51 publications

References 138 publications

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Breakthroughs in hepatology

Portal vein thrombosis in liver cirrhosis: An updated overview

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