Haemostasis in critically ill patients with advanced chronic liver disease

晚期慢性肝病危重患者的止血

基本信息

  • 批准号:
    MR/W030292/1
  • 负责人:
  • 金额:
    $ 31.3万
  • 依托单位:
  • 依托单位国家:
    英国
  • 项目类别:
    Research Grant
  • 财政年份:
    2022
  • 资助国家:
    英国
  • 起止时间:
    2022 至 无数据
  • 项目状态:
    未结题

项目摘要

What is the link between blood clotting and liver disease? Liver disease is common and is now the largest cause of death in adults aged 30 to 59 years of age. Two serious complications of liver disease are bleeding and blood clots (thrombosis). Bleeding affects up to 1 in 10 adults with liver disease per year and blood clots up to 1 in 20 adults with liver disease per year. Most bleeding is due to pressure changes in the blood vessels in the abdomen leading to swelling of veins around the oesophagus (called varices). What is known about blood clotting in liver disease? The liver produces many of the substances involved in blood clotting, and patients with liver disease often have marked abnormalities in blood clotting measured with routinely available tests. This is because routinely available tests only measure the effect of proteins which increase blood clotting (pro-coagulants). In liver disease, the proteins which reduce blood clotting (anti-coagulants) are also reduced and overall, clotting is thought to be 'rebalanced'. Specialist tests (thrombin generation and thromboelastography) which are able to measure either the effect of the body's anti-coagulants or blood cells demonstrate that clotting is actually normal or increased in most patients with liver disease. Why are blood tests to measure blood clotting in liver disease important? Current routine tests are poor at predicting bleeding and clotting complications in patients with liver disease. Because the blood clotting tests in patients with liver disease look abnormal, treatments like transfusion of plasma (blood clotting proteins), platelets (small cells important for blood clotting) or fibrinogen (the final protein needed for blood clot formation) may be given to try and improve the blood test results, even though this might not reduce the risk of bleeding. In patients who are bleeding, the treatment approach is based on studies in different patient groups such as trauma where plasma transfusion has been shown to improve outcomes. In liver disease, studies show treatment with plasma can worsen bleeding from varices by increasing the pressure in the veins. Patients with liver disease are also at increased risk of thrombosis; most patients in hospital are given medications to reduce the risk of thrombosis ('blood thinners' or anticoagulants) but due to the changes seen on routine laboratory tests, doctors sometimes worry these medications might increase the risk of bleeding. Balancing the risks of bleeding and thrombosis and deciding which blood test results should be treated can be very difficult. This is particularly important in seriously ill patients as they are at higher risk of bleeding and thrombosis, and often need multiple procedures. What will I do? I will look at specialist blood tests (thrombin generation, thromboelastography, neutrophil extracellular traps) in patients with liver disease admitted to intensive care to see whether these tests could be used routinely to guide the need for transfusion and predict the risk of bleeding or thrombosis. I will also look at whether these tests remain the same over time and how transfusion changes the results. Why is this research important? As current tests are not helpful, many patients get transfusions when they probably don't need to. This is wasteful, costly and puts patients at risk of side effects. This is important both for patients with liver disease and bleeding (4000/year) and those having procedures/operations. Better tests will reassure doctors when transfusion is not needed and will improve management of bleeding complications and prevention of thrombosis in hospital.
凝血和肝脏疾病之间有什么联系?肝病很常见,现在是30至59岁成年人死亡的最大原因。肝脏疾病的两个严重并发症是出血和血栓形成。每年有1 / 10的肝脏疾病患者会出现出血,1 / 20的肝脏疾病患者会出现血栓。大多数出血是由于腹部血管的压力变化导致食道周围静脉肿胀(称为静脉曲张)。我们对肝病中的血液凝固了解多少?肝脏产生许多与血液凝固有关的物质,肝病患者通常有明显的血液凝固异常。这是因为常规可用的测试只测量促进血液凝固的蛋白质(促凝剂)的效果。在肝脏疾病中,减少血液凝固的蛋白质(抗凝血剂)也会减少,总的来说,凝血被认为是“重新平衡”的。专业测试(凝血酶生成和血栓弹性成像)能够测量身体抗凝剂或血细胞的效果,证明大多数肝病患者的凝血实际上是正常的或增加的。为什么检测肝病患者血液凝固情况的血液检查很重要?目前的常规检查在预测肝病患者出血和凝血并发症方面效果较差。由于肝病患者的凝血检查结果看起来不正常,因此可能会采取输血血浆(凝血蛋白)、血小板(对凝血很重要的小细胞)或纤维蛋白原(形成血栓所需的最终蛋白质)等治疗措施,试图改善血液检查结果,尽管这可能不会降低出血的风险。对于出血的患者,治疗方法是基于对不同患者群体的研究,如创伤患者,输血已被证明可以改善结果。在肝脏疾病中,研究表明用血浆治疗会增加静脉压力,从而加重静脉曲张出血。肝病患者血栓形成的风险也会增加;医院给大多数病人开了降低血栓形成风险的药物(“血液稀释剂”或抗凝剂),但由于常规实验室检查的变化,医生有时担心这些药物可能会增加出血的风险。平衡出血和血栓形成的风险并决定哪些血液检查结果应该治疗是非常困难的。这对重病患者尤其重要,因为他们出血和血栓形成的风险较高,通常需要多次手术。我该怎么办?我将研究重症监护的肝病患者的专科血液检查(凝血酶生成、血栓弹性成像、中性粒细胞胞外陷阱),看看这些检查是否可以常规用于指导输血需求和预测出血或血栓形成的风险。我还将研究这些测试是否随着时间的推移而保持不变,以及输血如何改变结果。为什么这项研究很重要?由于目前的测试没有帮助,许多患者在可能不需要输血的情况下接受了输血。这种做法既浪费又昂贵,还会使患者面临副作用的风险。这对肝脏疾病和出血患者(4000/年)和接受手术的患者都很重要。当不需要输血时,更好的检测将使医生放心,并将改善出血并发症的管理和预防医院血栓形成。

项目成果

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Lara Roberts其他文献

Haemostasis in cirrhosis: Understanding destabilising factors during acute decompensation
肝硬化止血:了解急性失代偿期间的不稳定因素
  • DOI:
    10.1016/j.jhep.2023.01.010
  • 发表时间:
    2023-05-01
  • 期刊:
  • 影响因子:
    33.000
  • 作者:
    Alberto Zanetto;Patrick Northup;Lara Roberts;Marco Senzolo
  • 通讯作者:
    Marco Senzolo
Does the Use of Viscoelastic Hemostatic Assays for Periprocedural Hemostasis Management in Liver Disease Improve Clinical Outcomes?
在肝病围手术期止血管理中使用粘弹性止血检测是否能改善临床结果?
  • DOI:
    10.1016/j.tmrv.2024.150823
  • 发表时间:
    2024-07-01
  • 期刊:
  • 影响因子:
    2.500
  • 作者:
    Suzanne Maynard;Elizabeth Marrinan;Lara Roberts;Simon Stanworth
  • 通讯作者:
    Simon Stanworth
Systematic review of the use of ultrasound for venous assessment and venous thrombosis screening in spaceflight
超声在航天飞行中用于静脉评估和静脉血栓筛查的系统评价
  • DOI:
    10.1038/s41526-024-00356-w
  • 发表时间:
    2024-02-05
  • 期刊:
  • 影响因子:
    4.100
  • 作者:
    Antoine Elias;Tobias Weber;David A. Green;Katie M. Harris;Jonathan M. Laws;Danielle K. Greaves;David S. Kim;Lucia Mazzolai-Duchosal;Lara Roberts;Lonnie G. Petersen;Ulrich Limper;Andrej Bergauer;Michael Elias;Andrew Winnard;Nandu Goswami
  • 通讯作者:
    Nandu Goswami

Lara Roberts的其他文献

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