HEMOSTATIC DISORDERS IN LIVER DISEASES
https://doi.org/10.15825/1995-1191-2010-2-82-91
Abstract
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.
About the Authors
A. F. MinovBelarus
A. M. Dzyadzko
Belarus
O. O. Rummo
Belarus
References
1. Agarwal S., Joyner K.A.Jr., Swaim M.W. Ascites fluid as a possible origin for hyperfibrinolysis in advanced liver disease // Am. J. Gastroenterol. 2000. Vol. 95. P. 3218– 3224.
2. Albornoz L. et al. Von Willebrand factor could be an in- dex of endothelial dysfunction in patients with cirrhosis: relationship to degree of liver failure and nitric oxide le- vels // J. Hepatol. 1999. Vol. 30. P. 451–455.
3. Ben-Ari Z., Osman E., Hutton R.A., Burroughs A.K. Dis- seminated intravascular coagulation in liver cirrhosis: fact or fiction? // Am. J. Gastroenterol. 1999. Vol. 94. P. 2977–2982.
4. Bhattacharyya M. et al. Inherited prothrombotic defects in Budd-Chiari syndrome and portal vein thrombosis: a study from North India // Am. J. Clin. Pathol. 2004. Vol. 121. P. 844–847.
5. Bismuth H. et al. Orthotopic liver transplantation in ful- minant and subfulminant hepatitis. The Paul Brousse ex- perience // Ann. Surg. 1995. Vol. 222. P. 109–119.
6. Bosch J. et al. Recombinant factor VIIa for upper gas- trointestinal bleeding in patients with cirrhosis: a ran- domized, double-blind trial // Gastroenterology. 2004. Vol. 127. P. 1123–1130.
7. Burroughs A.K. et al. Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study // J. Hepatol. 2002. Vol. 37. P. 463–470.
8. Burroughs A.K. et al. Anticoagulation after liver trans- plantation: a retrospective audit and case-control study // Blood Coagul Fibrinolysis. 2009. Vol. 8 (20). P. 615– 618.
9. Carmassi F., Morale M., De Negri F., Carrai M. Mo- dulation of hemostatic balance with antithrombin III re- placement therapy in a case of liver cirrhosis associated with recurrent venous thrombosis // J. Mol. Med. 1995. Vol. 73. P. 89–93.
10. Carr J.M. Disseminated intravascular coagulation in cir- rhosis // Hepatology. 1989. Vol. 10. P. 103–110.
11. Cerutti E. et al. Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation // Liver. Transpl. 2004. Vol. 10. P. 289–294.
12. Clavien P.A. et al. Definition and classification of nega- tive outcomes in solid organ transplantation. Applica- tion in liver transplantation // Ann. Surg. 1994. Vol. 220. P. 109–120.
13. Dalmau A. et al. The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: a com- parative study // Liver. Transpl. 2004. Vol. 10. P. 279– 284.
14. Ejlersen E. et al. Recombinant activated factor VII (rFVIIa) acutely normalizes prothrombin time in patients with cirrhosis during bleeding from oesophageal varices. Scand // J. Gastroenterol. 2001. Vol. 36. P. 1081–1085.
15. Escolar G. et al. Evaluation of acquired platelet dysfunc- tions in uremic and cirrhotic patients using the platelet function analyzer (PFA-100): influence of hematocrit elevation // Haematologica. 1999. Vol. 84. P. 614–619.
16. Espiritu J.D. Pulmonary embolism in a patient with co- agulopathy from end-stage liver disease // Chest. 2000. Vol. 117. P. 924–925.
17. Everson G.T. A hepatologist’s perspective on the ma- nagement of coagulation disorders before liver transplan- tation // Liver. Transpl. Surg. 1997. Vol. 3. P. 646–652.
18. Ewe K. Bleeding after liver biopsy does not correlate with indices of peripheral coagulation // Dig. Dis. Sci. 1981. Vol. 26. P. 388–393.
19. Franchis R. et al. Radomized controlled trial of desmo- pressin plus terlipressin vs. terlipressin alone for the tre- atment of acute variceal hemorrhage in cirrhotic patients: a multicenter, double-blind study. New Italian Endosco- pic Club // Hepatology. 1993. Vol. 18. P. 1102–1107.
20. Francis J.L., Armstrong D.J. Fibrinogen-bound sialic acid levels in the dysfibrinogenaemia of liver disease // Haemostasis. 1982. Vol. 11. P. 215–222.
21. Garrison R.N., Cryer H.M., Howard D.A., Polk H.C.Jr. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis // Ann. Surg. 1984. Vol. 199. P. 648–655.
22. Grant A., Neuberger J. Guidelines on the use of liver biopsy in clinical practice // British Society of Gastroen- terology. Gut. 1999. Vol. 45 Suppl. 4. P. IV1–IV11.
23. Hersch S.L., Kunelis T., Francis R.B.Jr. The pathogene- sis of accelerated fibrinolysis in liver cirrhosis: a critical role for tissue plasminogen activator inhibitor // Blood. 1987. Vol. 69. P. 1315–1319.
24. Hou M.C. et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemor-
25. rhage: a randomized trial // Hepatology. 2004. Vol. 39.P. 746–753.
26. Hutchison D.E. et al. Platelet changes following clinical and experimental hepatic homotransplantation // Arch.
27. Surg. 1968. Vol. 97. P. 27–33.
28. Kamath P.S. et al. A model to predict survival in patients with end-stage liver disease // Hepatology. 2001. Vol. 33.
29. P. 464–470.
30. Kang Y.G. et al. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver trans-
31. plantation // Anesth. Analg. 1985. Vol. 64. P. 888–896.
32. Kang Y.G. et al. Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation // Anesthesio-
33. logy. 1987. Vol. 66. P. 766–773.
34. Kerr R. et al. Effects of acute liver injury on blood coagulation // J. Thromb Haemost. 2003. Vol. 1. P. 754–759.
35. Kerr R. New insights into haemostasis in liver failure // Blood Coagul. Fibrinolysis. 2003. Vol. 14. (Suppl 1).
36. P. S43–S45.
37. Jeffers L. et al. Safety and efficacy of recombinant factor VIIa in patients with liver disease undergoing laparo- scopic liver biopsy // Gastroenterology. 2002. Vol. 123. P. 118–126.
38. Mangano D.T., Tudor I.C., Dietzel C. The risk associ- ated with aprotinin in cardiac surgery // N. Engl. J. Med. 2006. Vol. 354. P. 353–365.
39. Mannucci P.M., Vigano S. Deficiencies of protein C, an inhibitor of blood coagulation // Lancet. 1982. Vol. 2. P. 463–467.
40. Meijer K. et al. Recombinant factor VIIa in orthotopic liver transplantation: influence on parameters of coa- gulation and fibrinolysis // Blood Coagul Fibrinolysis. 2003. Vol. 14. P. 169–174.
41. Moriau M., Kestens P.J., Masure R. Heparin and an- tifibrinolytic agents during experimental hepatectomy and liver transplantation // Pathol Eur. 1969. Vol. 4. P. 172–182.
42. Palomo Sanchez J.C. et al. Effects of intraopera- tive blood transfusion on postoperative complications and survival after orthotopic liver transplantation// Hepatogastroenterology. 1998. Vol. 45. P. 1026–1033.
43. Perkins L., Jeffries M., Patel T. Utility of preoperative scores for predicting morbidity after cholecystectomy in patients with cirrhosis // Clin. Gastroenterol. Hepatol. 2004. Vol. 2. P. 1123–1128.
44. Pernambuco J.R. et al. Activation of the fibrinolytic sys- tem in patients with fulminant liver failure // Hepatol- ogy. 1993. Vol. 18. P. 1350–1356.
45. Salooja N., Perry D.J. Thrombelastography // Blood Co- agul Fibrinolysis. 2001. Vol. 12. P. 327–337.
46. Senzolo M. et al. New insights into the coagulopathy of liver disease and liver transplantation // World J. Gastro- enterol. 2006. Vol. 12 (48). P. 7725–7736.
47. Shore-Lesserson L. Point-of-care coagulation monitor- ing for cardiovascular patients: past and present // J. Car- diothorac. Vasc. Anesth. 2002. Vol. 16. P. 99–106.
48. Steib A. et al. Intraoperative blood losses and transfu- sion requirements during adult liver transplantation re- main difficult to predict // Can J. Anaesth. 2001. Vol. 48. P. 1075–1079.
49. Thalheimer U. et al. Endogenous heparinoids in acute variceal bleeding // Gut. 2005. Vol. 54. P. 310–311.
50. Tripodi A. et al. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests // Hepatology. 2005. Vol. 41. P. 553–558.
51. Violi F. et al. Prognostic value of clotting and fibrinolytic systems in a follow-up of 165 liver cirrhotic patients. CALC Group // Hepatology. 1995. Vol. 22. P. 96–100.
52. Violi F. et al. Association between high values of D-di- mer and tissue-plasminogen activator activity and first
53. gastrointestinal bleeding in cirrhotic patients // CALC
54. Group. Thromb. Haemost. 1996. Vol. 76. P. 177–183. 47. Wanless I.R. et al. Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension // Hepatology. 1995.
55. Vol. 21. P. 1238–1247.
56. Wong A.Y. et al. Desmopressin does not decrease blood loss and transfusion requirements in patients undergoing hepatectomy // Can J. Anaesth. 2003. Vol. 50. P. 14–20.
Review
For citations:
Minov A.F., Dzyadzko A.M., Rummo O.O. HEMOSTATIC DISORDERS IN LIVER DISEASES. Russian Journal of Transplantology and Artificial Organs. 2010;12(2):82-91. (In Russ.) https://doi.org/10.15825/1995-1191-2010-2-82-91