The hemostatic and thrombotic complications of liver disease.

The hemostatic and thrombotic complications of liver disease.
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DOI:
10.1111/ejh.13688
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发表时间:
2021-10
影响因子:
3.1
通讯作者:
Shatzel, Joseph
Shatzel, Joseph
中科院分区:
医学3区
文献类型:
--
作者:
McMurry, Hannah Stowe;Jou, Janice;Shatzel, Joseph

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肝硬化会导致多种血液紊乱,导致止血环境复杂且难以重新平衡。常见血液学检测(包括 INR 和 aPTT)在评估肝硬化患者止血和血栓形成风险方面的效用有限,并且关于输血阈值和血栓并发症正确处理的共识不断发展。本综述总结了关键止血紊乱的病理生理学,包括血小板、冯维勒布兰德因子、促凝因子和抗凝因子以及纤维蛋白的紊乱。此外,还讨论了肝硬化主要血栓和出血并发症的发病机制、后果、最佳治疗和预防。
Hepatic cirrhosis leads to numerous hematologic derangements resulting in a complex and tenuously rebalanced hemostatic milieu. The utility of common hematologic tests including the INR and aPTT in assessing hemostatic and thrombotic risk in patients with cirrhosis is limited, and consensus on transfusion thresholds and proper management of thrombotic complications continues to evolve. This review summarizes the pathophysiology of key derangements of hemostasis including those of platelets, von Willebrand factor, pro- and anticoagulation factors, and fibrin. Additionally, the pathogenesis, consequences, optimal management, and prevention of major thrombotic and bleeding complications in cirrhosis arte discussed.
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