vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2010-2-82-91vtio-311Research ArticleОбзор литературыLiterature ReviewsНАРУШЕНИЯ ГЕМОСТАЗА ПРИ ЗАБОЛЕВАНИЯХ ПЕЧЕНИHEMOSTATIC DISORDERS IN LIVER DISEASESМиновА. Ф.MinovA. F.andrei.minou@gmail.comДзядзькоА. М.DzyadzkoA. M.РуммоО. О.RummoO. O.Учреждение здравоохранения «9-я городская клиническая больница», МинскБеларусь9th state clinical hospital, MinskBelarus201005062014122ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XII No 2–20108291Copyright © Минов А.Ф., Дзядзько А.М., Руммо О.О., 20102010Минов А.Ф., Дзядзько А.М., Руммо О.О.Minov A.F., Dzyadzko A.M., Rummo O.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/311

Печень играет ключевую роль в первичном и вторичном гемостазе, являясь местом синтеза всех факторов свертывания и их ингибиторов. Заболевания печени приводят к сложным изменениям в гемостазе, при этом сохраняется баланс между свертывающей и противосвертывающей системами, но со сниженным ре- зервом. Все больше накапливается данных о том, что тромбоз воротной и печеночных вен лежит в основе прогрессирования заболевания у пациентов с циррозом и усугубляет нарушения гемостаза. Эти наруше- ния гемостаза не всегда ведут к спонтанным кровотечениям, которые возникают только при наличии до- полнительных факторов, например инфекции. Обычно терапия расстройств коагуляции при заболеваниях печени требуется во время кровотечения или перед выполнением инвазивных процедур. У пациентов с заболеваниями печени в их конечной стадии трансплантация является единственным возможным методом лечения, который способен восстановить нормальный гемостаз и скорригировать генетические дефекты свертывания. Во время трансплантации печени кровотечения обусловлены сопутствующей гипокоагуля- цией, развитостью коллатеральной венозной сети вследствие портальной гипертензии и усилением актив- ности фибринолиза. 

The liver is an essential player in the pathway of coagulation in both primary and secondary hemostasis as it is the site of synthesis of all coagulation factors and their inhibitors. Liver diseases are associated with complex changes in coagulation and the delicate balance between pro and antithrombotic factors is preserved but reset to a lower level. There is growing evidence that portal and hepatic vein thrombosis is cause of disease progression in cirrhotic patients and worsens hemostatic abnormalities. These hemostatic abnormalities do not always lead to spontaneous bleeding, which may be triggered only by additional factors, such as infections. Usually therapy for coagulation disorders in liver disease is needed only during bleeding or before invasive procedures. In patients with end stage liver disease liver transplantation is the only treatment available, which can restore normal hemostasis, and correct genetic clotting defects. During liver transplantation hemorrhage may occur due to the pre-existing hypocoagulable state, the collateral circulation caused by portal hypertension and increased fibrinolysis. 

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