Hemostasis, bleeding and thrombosis in liver disease.
Hemostasis, bleeding and thrombosis in liver disease.
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DOI：
10.15761/jts.1000182
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发表时间：
2017-05
期刊：
影响因子：
--
通讯作者：
Bonder A
中科院分区：
文献类型：
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作者：
Flores B;Trivedi HD;Robson SC;Bonder A
肝硬化的存在会增加慢性肝病患者血栓形成和出血的风险。这种二元性是肝硬化个体中促凝血和抗凝状态之间动态不平衡的结果。肝硬化中这种失衡的机制尚不清楚。众所周知，肝硬化的进展导致合成功能降低和同时缺乏天然抗凝剂。其他提出的导致这种止血失衡的机制包括血小板生成减少、脾功能亢进导致的血小板破坏增加、维生素K依赖性和非依赖性凝血因子和抗凝因子的合成减少以及嘌呤能信号通路的改变。鉴于目前我们对肝硬化出血和血栓形成倾向的认识不稳定，对这些疾病的治疗建议仍在不断发展。我们提供了一个最新的肝硬化止血和血栓形成倾向改变的病理生理学的建议。我们讨论了门静脉血栓形成（PVT）和静脉血栓栓塞（VTE）的最新研究，这是肝硬化常见的血栓性后果，导致实质性的发病率和死亡率。为了解决这些问题，我们讨论了新的预防性干预措施和目前的治疗方案，以管理肝硬化血栓形成的高风险，同时限制出血性并发症。
The presence of cirrhosis poses an increased risk of both thrombosis and bleeding in individuals with chronic liver disease. This duality is a result of a dynamic disequilibrium between procoagulant and anticoagulant states in individuals with cirrhosis. The mechanism of this imbalance in cirrhosis remains unclear. It is known that the progression of cirrhosis leads to decreased synthetic function and a concurrent lack of natural anticoagulants. Other proposed mechanisms contributing to this hemostatic imbalance include decreased platelet production, increased platelet destruction from hypersplenism, decreased synthesis of Vitamin K-dependent and independent clotting factors and anticoagulant factors, and alterations in purinergic signaling pathways. Given the current state of flux in our understanding of bleeding and thrombophilia in cirrhosis, the recommendations for treatment of these conditions are still evolving. We provide a current update on the proposed pathophysiology of altered hemostasis and thrombophilia in cirrhosis. We discuss recent studies in portal vein thrombosis (PVT) and venous thromboembolism (VTE), which are the common thrombotic consequences of cirrhosis, resulting in substantive morbidity and mortality. To address these, we discuss new prophylactic interventions and current treatment options to manage the heightened risk of thrombosis in cirrhosis, while limiting hemorrhagic complications.