The Nature of Changes in the Hemostatic System in Liver Cirrhosis

Tugushev Aliy Saitovich; Cherkovska Olga Stepanivna

doi:doi:10.11648/j.ejcbs.20210706.13

| Peer-Reviewed

The Nature of Changes in the Hemostatic System in Liver Cirrhosis

Tugushev Aliy Saitovich, Cherkovska Olga Stepanivna

Published in European Journal of Clinical and Biomedical Sciences (Volume 7, Issue 6)

Received: 31 August 2021 Accepted: 8 October 2021 Published: 23 November 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper- or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra- and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system - pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.

Published in	European Journal of Clinical and Biomedical Sciences (Volume 7, Issue 6)
DOI	10.11648/j.ejcbs.20210706.13
Page(s)	99-110
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Liver Cirrhosis, Hemostasis System, Bleeding, Thrombosis, Diagnosis, Treatment

References

[1]	Caldwell, S., & Carlini, L. E. (2020). Coagulation Homeostasis in Liver Disease. Clinical liver disease, 16 (4), 137–141. https://doi.org/10.1002/cld.935.
[2]	Driever, E. G., Stravitz, R. T., Zhang, J., Adelmeijer, J., Durkalski, V., Lee, W. M., & Lisman, T. (2021). VWF/ADAMTS13 Imbalance, But Not Global Coagulation or Fibrinolysis, Is Associated With Outcome and Bleeding in Acute Liver Failure. Hepatology (Baltimore, Md.), 73 (5), 1882–1891. https://doi.org/10.1002/hep.31507.
[3]	Kodali, S., & Singal, A. K. (2020). Portal and Mesenteric Venous Thrombosis. Clinical liver disease, 16 (4), 142–145. https://doi.org/10.1002/cld.938.
[4]	Northup, P. G., Garcia-Pagan, J. C., Garcia-Tsao, G., Intagliata, N. M., Superina, R. A., Roberts, L. N., Lisman, T., & Valla, D. C. (2021). Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients with Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md.), 73 (1), 366–413. https://doi.org/10.1002/hep.31646.
[5]	Premkumar, M., & Sarin, S. K. (2020). Current Concepts in Coagulation Profile in Cirrhosis and Acute-on-Chronic Liver Failure. Clinical liver disease, 16 (4), 158–167. https://doi.org/10.1002/cld.976.
[6]	Shenoy, A., Jarava, D., Stotts, M. J., Intagliata, N. M. (2021). Anticoagulation Management in Patients with Atrial Fibrillation and Cirrhosis. Clinical Liver Disease, 17 (4), 277-281. https://doi.org/10.1002/cld.1048.
[7]	Shah, N. L., & Caldwell, S. H. (2016). Assessing the risk of bleeding and clotting in cirrhosis. Clinical liver disease, 7 (2), 26–28. https://doi.org/10.1002/cld.528.
[8]	Singh, A. D., & Shalimar (2020). Use of Blood Products and Drugs Before Procedures in Patients With Cirrhosis. Clinical liver disease, 16 (4), 153–157. https://doi.org/10.1002/cld.906.
[9]	Tugushev, A. S, Vakulenko, V. V., Cherkovskaya, O. S., Mihantev, D. I., Neshta, V. V., Potapenko, P. I. (2015). Harakter izmenenij sistemy gemostaza u bolnyh cirrozom pecheni [Character of changes hemostasis system in patients with cirrhosis]. Science Rise – Science Rise, 5/4 (10), 28-32 [in Russian]. DOI: 10.15587/2313-8416.2015.43105.
[10]	Kumar, M., Ahmad, J., Maiwall, R., Choudhury, A., Bajpai, M., Mitra, L. G., Saluja, V., Mohan Agarwal, P., Bihari, C., Shasthry, S. M., Jindal, A., Bhardwaj, A., Kumar, G., & Sarin, S. K. (2020). Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial. Hepatology (Baltimore, Md.), 71 (1), 235–246. https://doi.org/10.1002/hep.30794.
[11]	European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu (2016). EASL Clinical Practice Guidelines: Vascular diseases of the liver. Journal of hepatology, 64 (1), 179–202. https://doi.org/10.1016/j.jhep.2015.07.040
[12]	Young, K., & Wong, R. (2018). Evaluation and management of acute and chronic portal vein thrombosis in patients with cirrhosis. Clinical liver disease, 10 (6), 152–156. https://doi.org/10.1002/cld.679.
[13]	Hidaka, H., Kokubu, S., Sato, T., Katsushima, S., Izumi, N., Igura, T., Asahara, S., Notsumata, K., Osaki, Y., Tsuji, K., Kawanaka, H., Akahoshi, T., Hirota, S., Matsutani, S., & NPB-06 study group (2018). Antithrombin III for portal vein thrombosis in patients with liver disease: A randomized, double-blind, controlled trial. Hepatology research: the official journal of the Japan Society of Hepatology, 48 (3), E107–E116. https://doi.org/10.1111/hepr.12934.
[14]	Kurokawa, T., Zheng, Y. W., & Ohkohchi, N. (2016). Novel functions of platelets in the liver. Journal of gastroenterology and hepatology, 31 (4), 745–751. https://doi.org/10.1111/jgh.13244.
[15]	Rassi, A. B., d'Amico, E. A., Tripodi, A., da Rocha, T., Migita, B. Y., Ferreira, C. M., Carrilho, F. J., & Farias, A. Q. (2020). Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation. Journal of hepatology, 72 (1), 85–94. https://doi.org/10.1016/j.jhep.2019.09.008.
[16]	Nowatari, T., Murata, S., Fukunaga, K., & Ohkohchi, N. (2014). Role of platelets in chronic liver disease and acute liver injury. Hepatology research: the official journal of the Japan Society of Hepatology, 44 (2), 165–172. https://doi.org/10.1111/hepr.12205.
[17]	Wannhoff, A., Friedrich, K., & Gotthardt, D. N. (2017). Reduced influence of procoagulant changes on survival in patients with advanced cirrhosis. Journal of hepatology, 66 (2), 454–455. https://doi.org/10.1016/j.jhep.2016.08.025.
[18]	Olson J. C. (2019). Thromboelastography-Guided Blood Product Use Before Invasive Procedures in Cirrhosis With Severe Coagulopathy: A Randomized Controlled Trial. Clinical liver disease, 13 (4), 102–105. https://doi.org/10.1002/cld.749.
[19]	Stravitz R. T. (2017). Thrombosis and coagulopathy in the liver transplant candidate and recipient. Clinical liver disease, 9 (1), 11–17. https://doi.org/10.1002/cld.606.
[20]	Intagliata, N. M., Ferreira, C. N., & Caldwell, S. H. (2016). Anticoagulation for portal vein thrombosis in cirrhosis. Clinical liver disease, 7 (6), 126–131. https://doi.org/10.1002/cld.552.
[21]	La Mura, V., Tripodi, A., Tosetti, G., Cavallaro, F., Chantarangkul, V., Colombo, M., & Primignani, M. (2016). Resistance to thrombomodulin is associated with de novo portal vein thrombosis and low survival in patients with cirrhosis. Liver international: official journal of the International Association for the Study of the Liver, 36 (9), 1322–1330. https://doi.org/10.1111/liv.13087.
[22]	Moore A. H. (2019). Thrombocytopenia in Cirrhosis: A Review of Pathophysiology and Management Options. Clinical liver disease, 14 (5), 183–186. https://doi.org/10.1002/cld.860.
[23]	Nephew, L. D., & Goldberg, D. S. (2016). Impact of Anticoagulation on Upper Gastrointestinal Bleeding in Cirrhosis. Gastroenterology, 150 (5), 1239–1241. https://doi.org/10.1053/j.gastro.2016.03.024.
[24]	Kalambokis, G. N., Oikonomou, A., Baltayiannis, G., Christou, L., Kolaitis, N. I., & Tsianos, E. V. (2016). Thrombin generation measured as thrombin-antithrombin complexes predicts clinical outcomes in patients with cirrhosis. Hepatology research: the official journal of the Japan Society of Hepatology, 46 (3), E36–E44. https://doi.org/10.1111/hepr.12520.
[25]	Loffredo, L., Pastori, D., Farcomeni, A., & Violi, F. (2017). Effects of Anticoagulants in Patients with Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-analysis. Gastroenterology, 153 (2), 480–487. e1. https://doi.org/10.1053/j.gastro.2017.04.042.
[26]	Bishnu, S., Ahammed, S. M., Sarkar, A., Hembram, J., Chatterjee, S., Das, K., Dhali, G. K., Chowdhury, A., & Das, K. (2018). Effects of atorvastatin on portal hemodynamics and clinical outcomes in patients with cirrhosis with portal hypertension: a proof-of-concept study. European journal of gastroenterology & hepatology, 30 (1), 54–59. https://doi.org/10.1097/MEG.0000000000001006.
[27]	Tang, W., Wang, Y., Zhao, X., Wang, X., Zhang, T., Ou, X., Shou, W., You, H., & Jia, J. (2015). Procoagulant imbalance aggravated with falling liver function reserve, but not associated with the presence of portal vein thrombosis in cirrhosis. European journal of gastroenterology & hepatology, 27 (6), 672–678. https://doi.org/10.1097/MEG.0000000000000352.
[28]	Balaphas, A., Meyer, J., Sadoul, K., Fontana, P., Morel, P., Gonelle-Gispert, C., & Bühler, L. H. (2019). Platelets and Platelet-Derived Extracellular Vesicles in Liver Physiology and Disease. Hepatology communications, 3 (7), 855–866. https://doi.org/10.1002/hep4.1358.
[29]	La Mura, V., Braham, S., Tosetti, G., Branchi, F., Bitto, N., Moia, M., Fracanzani, A. L., Colombo, M., Tripodi, A., & Primignani, M. (2018). Harmful and Beneficial Effects of Anticoagulants in Patients with Cirrhosis and Portal Vein Thrombosis. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 16 (7), 1146–1152. e4. https://doi.org/10.1016/j.cgh.2017.10.016.
[30]	Xu, X., Guo, X., De Stefano, V., Silva-Junior, G., Goyal, H., Bai, Z., Zhao, Q., & Qi, X. (2019). Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Hepatology international, 13 (4), 468–481. https://doi.org/10.1007/s12072-019-09951-6.
[31]	Zermatten, M. G., Fraga, M., Moradpour, D., Bertaggia Calderara, D., Aliotta, A., Stirnimann, G., De Gottardi, A., & Alberio, L. (2020). Hemostatic Alterations in Patients With Cirrhosis: From Primary Hemostasis to Fibrinolysis. Hepatology (Baltimore, Md.), 71 (6), 2135–2148. https://doi.org/10.1002/hep.31201.
[32]	Sherlock Sh., Dooley J. (2002). Diseases of the liver and biliary tract: a practical guide/Transl. From English; Edited by Z. G. Aprosina, N. A. Mukhina.- M.: GEOTAR-MED.- 864.
[33]	Stravitz R. T. (2018). Algorithms for managing coagulation disorders in liver disease. Hepatology International, 12 (5), 390–401. https://doi.org/10.1007/s12072-018-9886-6.
[34]	Intagliata, N. M., & Caldwell, S. H. (2014). Management of disordered hemostasis and coagulation in patients with cirrhosis. Clinical liver disease, 3 (6), 114–117. https://doi.org/10.1002/cld.333.
[35]	Rank, K. M., & Lake, J. (2018). CON: Anticoagulation for Portal Vein Thrombosis in Advanced Cirrhosis. Clinical liver disease, 12 (3), 80–82. https://doi.org/10.1002/cld.713.
[36]	Blasi, A., Patel, V. C., Adelmeijer, J., Azarian, S., Hernandez Tejero, M., Calvo, A., Fernández, J., Bernal, W., & Lisman, T. (2020). Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those with Complications and Poor Survival. Hepatology (Baltimore, Md.), 71 (4), 1381–1390. https://doi.org/10.1002/hep.30915.
[37]	Intagliata, N. M., & Caldwell, S. H. (2017). Changes in hemostasis in liver disease. Journal of hepatology, 67 (6), 1332–1333. https://doi.org/10.1016/j.jhep.2017.07.001.
[38]	To, U. K., & Garcia-Tsao, G. (2018). PRO: Patients with Advanced Cirrhosis and Portal Vein Thrombosis Should Receive Anticoagulation. Clinical liver disease, 12 (3), 74–79. https://doi.org/10.1002/cld.717.
[39]	Shenoy, A., & Intagliata, N. M. (2020). Thromboelastography and Utility in Hepatology Practice. Clinical liver disease, 16 (4), 149–152. https://doi.org/10.1002/cld.947.
[40]	Primignani, M., & La Mura, V. (2014). Diagnosis of thrombophilia/prothrombotic conditions in patients with liver disease. Clinical liver disease, 3 (6), 126–128. https://doi.org/10.1002/cld.342.
[41]	Furuichi, Y., Takeuchi, H., Yoshimasu, Y., Kasai, Y., Abe, M., & Itoi, T. (2020). Thrombopoietin receptor agonist is more effective than platelet transfusion for chronic liver disease with thrombocytopenia, shown by propensity score matching. Hepatology research: the official journal of the Japan Society of Hepatology, 50 (9), 1062–1070. https://doi.org/10.1111/hepr.13530.
[42]	Mancuso A. (2016). Management of portal vein thrombosis in cirrhosis: an update. European journal of gastroenterology & hepatology, 28 (7), 739–743. https://doi.org/10.1097/MEG.0000000000000633.
[43]	Peck-Radosavljevic M. (2017). Thrombocytopenia in chronic liver disease. Liver international: official journal of the International Association for the Study of the Liver, 37 (6), 778–793. https://doi.org/10.1111/liv.13317.
[44]	Ahmed, Z., Singal, A. K., & Kamath, P. S. (2020). Anticoagulants and Their Monitoring. Clinical liver disease, 16 (4), 146–148. https://doi.org/10.1002/cld.946.
[45]	Tugushev, A. S., Mihantev, D. I., Neshta, V. V., Cherkovskaya, O. S., Ryazanova, E. D. (2015). Korrekciya sistemy gemostaza u bolnyh cirrozom pecheni [Correction of the hemostasis system in patients with liver cirrhosis]. Zaporizkij medichnij zhurnal – Zaporozhye medical journal, 5 (92), 45-48 [in Russian]. https://doi.org/10.14739/2310-1210.2015.5.53772.
[46]	Stine, J. G., Wang, J., Shah, P. M., Argo, C. K., Intagliata, N., Uflacker, A., Caldwell, S. H., & Northup, P. G. (2018). Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case-control study. Liver international: official journal of the International Association for the Study of the Liver, 38 (1), 94–101. https://doi.org/10.1111/liv.13500.

Cite This Article

Plain Text BibTeX RIS

APA Style

Tugushev Aliy Saitovich, Cherkovska Olga Stepanivna. (2021). The Nature of Changes in the Hemostatic System in Liver Cirrhosis. European Journal of Clinical and Biomedical Sciences, 7(6), 99-110. https://doi.org/10.11648/j.ejcbs.20210706.13

Copy | Download

ACS Style

Tugushev Aliy Saitovich; Cherkovska Olga Stepanivna. The Nature of Changes in the Hemostatic System in Liver Cirrhosis. Eur. J. Clin. Biomed. Sci. 2021, 7(6), 99-110. doi: 10.11648/j.ejcbs.20210706.13

Copy | Download

AMA Style

Tugushev Aliy Saitovich, Cherkovska Olga Stepanivna. The Nature of Changes in the Hemostatic System in Liver Cirrhosis. Eur J Clin Biomed Sci. 2021;7(6):99-110. doi: 10.11648/j.ejcbs.20210706.13

Copy | Download

@article{10.11648/j.ejcbs.20210706.13,
  author = {Tugushev Aliy Saitovich and Cherkovska Olga Stepanivna},
  title = {The Nature of Changes in the Hemostatic System in Liver Cirrhosis},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {7},
  number = {6},
  pages = {99-110},
  doi = {10.11648/j.ejcbs.20210706.13},
  url = {https://doi.org/10.11648/j.ejcbs.20210706.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20210706.13},
  abstract = {The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper- or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra- and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system - pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - The Nature of Changes in the Hemostatic System in Liver Cirrhosis
AU  - Tugushev Aliy Saitovich
AU  - Cherkovska Olga Stepanivna
Y1  - 2021/11/23
PY  - 2021
N1  - https://doi.org/10.11648/j.ejcbs.20210706.13
DO  - 10.11648/j.ejcbs.20210706.13
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 99
EP  - 110
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20210706.13
AB  - The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper- or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra- and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system - pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.
VL  - 7
IS  - 6
ER  -

Copy | Download

Author Information

Tugushev Aliy Saitovich

Department of Faculty Surgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
Cherkovska Olga Stepanivna

Department of Faculty Surgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Tugushev Aliy Saitovich, Cherkovska Olga Stepanivna. (2021). The Nature of Changes in the Hemostatic System in Liver Cirrhosis. European Journal of Clinical and Biomedical Sciences, 7(6), 99-110. https://doi.org/10.11648/j.ejcbs.20210706.13

Copy | Download

ACS Style

Tugushev Aliy Saitovich; Cherkovska Olga Stepanivna. The Nature of Changes in the Hemostatic System in Liver Cirrhosis. Eur. J. Clin. Biomed. Sci. 2021, 7(6), 99-110. doi: 10.11648/j.ejcbs.20210706.13

Copy | Download

AMA Style

Tugushev Aliy Saitovich, Cherkovska Olga Stepanivna. The Nature of Changes in the Hemostatic System in Liver Cirrhosis. Eur J Clin Biomed Sci. 2021;7(6):99-110. doi: 10.11648/j.ejcbs.20210706.13

Copy | Download

@article{10.11648/j.ejcbs.20210706.13,
  author = {Tugushev Aliy Saitovich and Cherkovska Olga Stepanivna},
  title = {The Nature of Changes in the Hemostatic System in Liver Cirrhosis},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {7},
  number = {6},
  pages = {99-110},
  doi = {10.11648/j.ejcbs.20210706.13},
  url = {https://doi.org/10.11648/j.ejcbs.20210706.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20210706.13},
  abstract = {The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper- or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra- and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system - pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - The Nature of Changes in the Hemostatic System in Liver Cirrhosis
AU  - Tugushev Aliy Saitovich
AU  - Cherkovska Olga Stepanivna
Y1  - 2021/11/23
PY  - 2021
N1  - https://doi.org/10.11648/j.ejcbs.20210706.13
DO  - 10.11648/j.ejcbs.20210706.13
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 99
EP  - 110
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20210706.13
AB  - The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper- or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra- and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system - pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.
VL  - 7
IS  - 6
ER  -

Copy | Download