Use of Blood Products and Drugs Before Procedures in Patients With Cirrhosis

Singh, Achintya D.; Shalimar, S.

doi:10.1002/cld.906

Cited by 3 publications

(8 citation statements)

References 13 publications

(22 reference statements)

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“…Primary thrombosis (portal and hepatic veins, intrahepatic portal and hepatic venules), which develops in the vessels of an initially healthy liver, and thrombosis in liver cirrhosis are distinguished. Whether there is a connection between primary thrombosis and liver pathology, whether thrombosis is a consequence of a decompensated course of liver cirrhosis or the cause of its decompensation with the development of specific complications -these questions remain unresolved today [1,2,4,5,8,9]. In 2020, updates were issued to the American association for the Study of Liver Diseases practice guidelines on liver vascular disease, thrombosis, and bleeding in patients with liver pathology, where the generally accepted data on the pathophysiological and clinical features of hemostasis disorders in patients with cirrhosis were critically examined, which suggests further research in this direction [1,4].…”

Section: Resultsmentioning

confidence: 99%

“…Prophylactic platelet transfusions have a short-term effect, leading to a slight improvement in platelet count only, but thrombin formation and TEG parameters are not normalized. Finally, frequent platelet transfusions can lead to transfusion reactions, to refractoriness of platelets with the inability to achieve the desired number of platelets in subsequent transfusions [4,8,10,15,19,22,23,27,34].…”

Section: Procoagulantsmentioning

confidence: 99%

“…Despite the increase in platelet counts above 100x109/ml in the group of patients taking the drug, there was no statistically significant decrease in the incidence of hemorrhagic complications. The study evaluating eltrombopag was terminated prematurely due to an increase in the incidence of PVT [4,5,8].…”

Section: Procoagulantsmentioning

confidence: 99%

“…Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra-and extrahepatic. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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The Nature of Changes in the Hemostatic System in Liver Cirrhosis

Saitovich¹,

Stepanivna²

2021

EJCBS

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The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links -vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper-or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra-and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system -pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.

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Section: Resultsmentioning

confidence: 99%

Section: Procoagulantsmentioning

confidence: 99%

Section: Procoagulantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Nature of Changes in the Hemostatic System in Liver Cirrhosis

Saitovich¹,

Stepanivna²

2021

EJCBS

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“…However, most of the studies have shown that severe thrombocytopenia was associated with a higher risk of bleeding, although the cut-off values were different in several studies (50 × 10 9 /L-75 × 10 9 /L)[ 14 , 63 ]. Reflecting the recent findings showing that cirrhotic patients are more often on a procoagulant slope[ 14 , 63 ], conventional coagulation tests are limited in predicting bleeding risk in cirrhosis because they do not account for the true in vivo coagulation status[ 69 , 70 ]. A systematic review comparing cirrhotic patients with a prolonged INR to those with normal INR found no difference in bleeding between the groups[ 13 ].…”

Section: The Hemostasis Assessment Before Invasive Procedures In Patients With Cirrhosismentioning

confidence: 99%

Viscoelastic tests in liver disease: where do we stand now?

Buliarca

Horhat

Mocan

et al. 2021

WJG

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Hemostasis is a complex physiological process based on the balance between pro-coagulant and anticoagulant systems to avoid pathological bleeding or thrombosis. The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder, and cirrhotic patients were considered naturally anticoagulated. In the light of the new evidence, the theory of rebalanced hemostasis replaced the old concept. According to this model, the hemostatic alteration leads to a unique balance between pro-coagulant, anticoagulant, and fibrinolytic systems. But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors. The standard coagulation tests [INR (international normalized ratio), platelet count and fibrinogen] only explore parts of the hemostasis, not offering an entire image of the process. Rotational thromboelastometry (ROTEM) and thromboelastography (TEG) are both point of care viscoelastic tests (VET) that provide real-time and dynamic information about the entire hemostasis process, including clot initiation (thrombin generation), clot kinetics, clot strength, and clot stability (lysis). Despite prolonged PT/INR (international normalized ratio of prothrombin time) and low platelet counts, VET is within the normal range in many patients with both acute and chronic liver disease. However, bleeding remains the dominant clinical issue in patients with liver diseases, especially when invasive interventions are required. VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests, leading to decrial use of blood products transfusion. Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET. Although VET has shown its benefit, more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.

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Cirrhotic coagulopathy: A rebalanced hemostasis

Singh

Mucha²,

Lindenmeyer³

2022

CCJM

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Cirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic complications, challenging this dogma. We now recognize that in cirrhosis there is a simultaneous decrease in both clotting and anticlotting factors, leading to a new equilibrium. Conventional coagulation tests such as the platelet count and prothrombin time do not assess the reduced anticoagulation factors in cirrhosis and overestimate the bleeding risk, and any intervention based on these test results can lead to thrombotic complications. This article reviews the changes in hemostasis associated with cirrhosis, newer tests for assessing coagulation, and preprocedural minimization of coagulopathy.

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Use of Blood Products and Drugs Before Procedures in Patients With Cirrhosis

Cited by 3 publications

References 13 publications

The Nature of Changes in the Hemostatic System in Liver Cirrhosis

The Nature of Changes in the Hemostatic System in Liver Cirrhosis

Viscoelastic tests in liver disease: where do we stand now?

Cirrhotic coagulopathy: A rebalanced hemostasis

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