Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences
Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences
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DOI：
10.1182/blood-2010-02-261891
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发表时间：
2010-08-12
期刊：
影响因子：
20.3
通讯作者：
Porte, Robert J.
中科院分区：
文献类型：
--
作者：
Lisman, Ton;Porte, Robert J.
肝病患者经常会继发继发于其疾病的复杂的止血障碍。凝血酶原时间和血小板计数等常规实验室检查经常出现异常，表明存在低凝状态。更复杂的实验室测试表明，由于促止血途径和抗止血途径同时发生变化，肝病患者可能处于止血平衡状态。在临床上，这种重新平衡的止血系统体现在很大一部分肝病患者可以接受大手术而不需要输注血液制品。然而，肝病患者的凝血平衡相对不稳定，相当一部分患者同时出现出血和血栓并发症。尽管在侵入性操作之前通过凝血酶原时间和血小板计数指导的血液制品注射来预防性纠正肝病患者的止血异常仍然是常见的做法，但我们认为这一政策没有证据基础。在本文中，我们将针对肝衰竭患者有止血相关出血倾向的传统观念提供论证。将讨论这些止血管理新见解的后果。 （血。2010；116(6):878-885）
Patients with liver disease frequently acquire a complex disorder of hemostasis secondary to their disease. Routine laboratory tests such as the prothrombin time and the platelet count are frequently abnormal and point to a hypocoagulable state. With more sophisticated laboratory tests it has been shown that patients with liver disease may be in hemostatic balance as a result of concomitant changes in both pro- and antihemostatic pathways. Clinically, this rebalanced hemostatic system is reflected by the large proportion of patients with liver disease who can undergo major surgery without any requirement for blood product transfusion. However, the hemostatic balance in the patient with liver disease is relatively unstable as evidenced by the occurrence of both bleeding and thrombotic complications in a significant proportion of patients. Although it is still common practice to prophylactically correct hemostatic abnormalities in patients with liver disease before invasive procedures by administration of blood products guided by the prothrombin time and platelet count, we believe that this policy is not evidence-based. In this article, we will provide arguments against the traditional concept that patients with liver failure have a hemostasis-related bleeding tendency. Consequences of these new insights for hemostatic management will be discussed. (Blood. 2010;116(6):878-885)