Treatment of Patients with Cirrhosis

Ge, Phillip S.; Runyon, Bruce A.

doi:10.1056/nejmra1504367

Cited by 289 publications

(219 citation statements)

References 63 publications

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“…Patients with cirrhosis are at increased risk for gastrointestinal bleeding, mainly from esophageal varices or portal hypertensive gastropathy [2, 3]. In contrast to the dogma of auto-anticoagulation in cirrhosis, venous thrombosis is more common in patients with cirrhosis than in the general population [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function

Scheiner

Stammet

Pokorný

et al. 2018

Wien Klin Wochenschr

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SummaryBackgroundNon-malignant portal vein thrombosis (PVT) is common in patients with advanced liver disease. Anticoagulation (AC) increases the chances of recanalization and may improve liver function in patients with cirrhosis.AimWe retrospectively assessed the course of non-malignant PVT in patients receiving AC.MethodsParameters related to hepatic injury (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]), severity of disease (ascites) and synthesis function (albumin) as well as AC, rates of PVT regression/progression and AC-associated complications were documented.ResultsAmong 122 patients with PVT, 51 patients with non-malignant PVT (27 incomplete, 24 complete) were included, 12 patients (25%) received long-term AC therapy (≥9 months) as compared to 36 patients without long-term AC. We observed a trend towards higher regression rates with long-term AC of 58% (vs. 28% without AC; p = 0.08) and lower progression rates of 25% (vs. 42% without AC; p = 0.15). In the subgroup of patients with decompensation prior to PVT diagnosis (n = 39), long-term AC (n = 10, 25.6%) resulted in a significantly higher rate of PVT regression/resolution (70% vs. 24%, p = 0.031). Interestingly, AST/ALT tended to decrease (−19%/−16%) and the proportion of patients with ascites became lower (−33%) with long-term AC (without AC: ±0%). Furthermore, there was a significant improvement in albumin levels (+9%/+3.6 g/dl) when compared to patients without long-term AC (−2%/−0.8 g/dl; p = 0.04). Additionally, 10 patients were treated with direct oral anticoagulants (DOACs) for splanchnic vein thrombosis. Importantly, there were no AC-associated bleeding events in patients with conventional AC and one bleeding event in patients with DOAC treatment (10%).ConclusionOur findings support anticoagulation in patients with non-malignant PVT, since AC seems safe and associated with superior PVT regression rates and might also decrease hepatic injury and improve liver synthesis.

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Section: Introductionmentioning

confidence: 99%

Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function

Scheiner

Stammet

Pokorný

et al. 2018

Wien Klin Wochenschr

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“…Furthermore, antihypertensive and hypoglycemic drugs may increase liver burden and aggravate liver damage (44,45). In addition, liver damage is also a risk factor for hypertension, exhibiting an interaction effect (46). Therefore, patients with Fanconi syndrome accompanied by hypertension and type 2 diabetes may be subjected to a higher risk of liver damage when treated with adefovir dipivoxil compared with patients with Fanconi syndrome alone.…”

Section: Discussionmentioning

confidence: 99%

Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases

et al. 2016

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Abstract. The aim of the present study was to identify monitoring and prevention measures as well as predictive factors for early detection of renal toxicity associated with long-term administration of adefovir dipivoxil in order to avoid progression to Fanconi syndrome. Clinical data of 28 patients with Fanconi syndrome caused by long-term administration of adefovir dipivoxil for the treatment of chronic hepatitis B virus (HBV) infection were collected pre-and post-administration for analysis. Patients presented with fatigue, progressive systemic pain in multiple bones and joints, as well as difficulty in walking and pathological fractures in a number of severe cases. Laboratory examinations revealed hypophosphatemia, elevated serum cystatin C (Cys-C), elevated serum creatinine (SCr), reduced glomerular filtration rate (GFR), positive urinary protein, erythrocytes and glucose, as well as osteoporosis. In consequence, adefovir dipivoxil administration was stopped, and patients received concentrated divitamins, sodium phosphate syrup and calcitriol. Symptoms and abnormalities in laboratory examinations were significantly improved in all patients after 2-6 months. Therefore, serum phosphate, SCr, routine urine parameters, Cys-C and GFR should be monitored regularly in chronic HBV patients treated with adefovir dipivoxil. The following factors were identified as predictive of kidney damage and Fanconi syndrome: Age ≥40 years, living in rural areas, previous renal toxicity, estimated GFR (eGFR) <90 ml/min/1.73 m 2 , hypertension, diabetes, cirrhosis and duration of adefovir dipivoxil treatment exceeding 24 months. The present results indicate that timely termination of adefovir dipivoxil treatment and replacement with other antiviral agents is critical once renal impairment appears, and that it is necessary to change to other antiviral agents and prolong the interval of administration according to the eGFR level.

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“…Yet, over the last years, doubts regarding the use of NSBBs in critically ill cirrhosis patients have been raised as a consequence of potential detrimental effects of NSBBs in cirrhosis patients with refractory ascites [24] or spontaneous bacterial peritonitis (SBP) [25]]. Accordingly, it has been suggested that NSBBs may not be beneficial in cirrhosis patients who develop refractory ascites, hypotension, hepatorenal syndrome, SBP, sepsis, or severe alcoholic hepatitis [26]. While there is no data to support a general ban of beta-blockers in critically ill cirrhosis patients, discontinuation/temporary interruption/dose reduction of NSBBs has been suggested at the time of SBP, renal impairment, and hypotension [22,23,27].…”

Section: Therapeutic Aspects and Recommendations For Cirrhosis Patienmentioning

confidence: 99%

“…Some authors advise against using (prophylactic) anticoagulation in cirrhosis [26]. Others suggest using anticoagulation only in patients with occlusive portal vein thrombosis [20].…”

Section: Therapeutic Aspects and Recommendations For Cirrhosis Patienmentioning

confidence: 99%

Management of Coagulopathy during Bleeding and Invasive Procedures in Patients with Liver Failure

2018

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Alterations in hemostasis are a characteristic feature of advanced liver disease. Patients with coagulopathy of advanced liver disease are prone to bleedings and also thromboembolic events. Under stable conditions, cirrhosis patients show alterations in both pro- and anticoagulatory pathways, frequently resulting in a rebalanced hemostasis. This review summarizes current recommendations of management during bleeding and prior to invasive procedures in patients with cirrhosis.

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Treatment of Patients with Cirrhosis

Cited by 289 publications

References 63 publications

Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function

Anticoagulation in non-malignant portal vein thrombosis is safe and improves hepatic function

Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases

Management of Coagulopathy during Bleeding and Invasive Procedures in Patients with Liver Failure

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