中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 12
Dec.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(12): 2928-2931

Changes in hemostasis and clinical significance of coagulation function test in patients with liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2021.12.040

  • Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

Research funding:

The National Science and Technology Major Project (2018ZX10723203);

The National Science and Technology Major Project (2018ZX10302206);

National Natural Science Foundation of China (82070650);

National Key Research and Development Program of China (2017YFC0908100);

Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program (2017BT01S131);

Department of Science and Technology of Guangdong Province (2014B020228003);

Department of Science and Technology of Guangdong Province (2015B020226004);

Clinical Research Program of Nanfang Hospital, Southern Medical University (2020CR026);

Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education (LC2019ZD006);

President Foundation of Nanfang Hospital, Southern Medical University (2019Z003)

  • Received Date: 2021-07-07
  • Accepted Date: 2021-08-06
  • Published Date: 2021-12-20
    Abstract
  • The liver plays an important role in procoagulant and anticoagulant mechanisms in human body. There are complex changes in hemostasis in patients with liver cirrhosis, with the presence of interaction between the portal venous system and the peripheral system and differences in etiology, and such patients have a dual trend of hemorrhage and thrombosis. At present, there are certain limitations in coagulation function tests commonly used in clinical practice. The primary etiology and results of various coagulation tests should be considered before initiation of anticoagulant therapy for patients with liver cirrhosis, so as to make the best clinical decisions for patients.

     

    • FullText(HTML)
  • loading
    • References(50)
  • [1]
    O'LEARY JG, GREENBERG CS, PATTON HM, et al. AGA clinical practice update: Coagulation in cirrhosis[J]. Gastroenterology, 2019, 157(1): 34-43. e1. DOI: 10.1053/j.gastro.2019.03.070.
    [2]
    LATORRE R, VAQUERO J, RINCÓN D, et al. Determinants of platelet count are different in patients with compensated and decompensated cirrhosis[J]. Liver Int, 2016, 36(2): 232-239. DOI: 10.1111/liv.12908.
    [3]
    AREF S, SLEEM T, EL MENSHAWY N, et al. Antiplatelet antibodies contribute to thrombocytopenia associated with chronic hepatitis C virus infection[J]. Hematology, 2009, 14(5): 277-281. DOI: 10.1179/102453309X439818.
    [4]
    MITCHELL O, FELDMAN DM, DIAKOW M, et al. The pathophysiology of thrombocytopenia in chronic liver disease[J]. Hepat Med, 2016, 8: 39-50. DOI: 10.2147/HMER.S74612.
    [5]
    VINHOLT PJ, HVAS AM, NIELSEN C, et al. Reduced platelet activation and platelet aggregation in patients with alcoholic liver cirrhosis[J]. Platelets, 2018, 29(5): 520-527. DOI: 10.1080/09537104.2017.1349308.
    [6]
    ZHANG H, ZHANG S, ZHANG J, et al. Improvement of human platelet aggregation post-splenectomy with paraesophagogastric devascularization in chronic hepatitis B patients with cirrhotic hypersplenism[J]. Platelets, 2020, 31(8): 1019-1027. DOI: 10.1080/09537104.2019.1704715.
    [7]
    LISMAN T, BONGERS TN, ADELMEIJER J, et al. Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity[J]. Hepatology, 2006, 44(1): 53-61. DOI: 10.1002/hep.21231.
    [8]
    LISMAN T, ADELMEIJER J, de GROOT PG, et al. No evidence for an intrinsic platelet defect in patients with liver cirrhosis--studies under flow conditions[J]. J Thromb Haemost, 2006, 4(9): 2070-2072. DOI: 10.1111/j.1538-7836.2006.02122.x.
    [9]
    GROENEVELD DJ, POOLE LG, LUYENDYK JP. Targeting von Willebrand factor in liver diseases: A novel therapeutic strategy?[J]. J Thromb Haemost, 2021, 19(6): 1390-1408. DOI: 10.1111/jth.15312.
    [10]
    BACCOUCHE H, LABIDI A, FEKIH M, et al. Haemostatic balance in cirrhosis[J]. Blood Coagul Fibrinolysis, 2017, 28(2): 139-144. DOI: 10.1097/MBC.0000000000000561.
    [11]
    PRADHAN-SUNDD T, GUDAPATI S, KAMINSKI TW, et al. Exploring the complex role of coagulation factor Ⅷ in chronic liver disease[J]. Cell Mol Gastroenterol Hepatol, 2021, 12(3): 1061-1072. DOI: 10.1016/j.jcmgh.2021.02.014.
    [12]
    LEBRETON A, SINEGRE T, PEREIRA B, et al. Plasma hypercoagulability in the presence of thrombomodulin but not of activated protein C in patients with cirrhosis[J]. J Gastroenterol Hepatol, 2017, 32(4): 916-924. DOI: 10.1111/jgh.13493.
    [13]
    PATIL AG, BIHARI C, SHEWADE HD, et al. Decreased protein C function predicts mortality in patients with cirrhosis[J]. Int J Lab Hematol, 2018, 40(4): 466-472. DOI: 10.1111/ijlh.12836.
    [14]
    STEIN SF, HARKER LA. Kinetic and functional studies of platelets, fibrinogen, and plasminogen in patients with hepatic cirrhosis[J]. J Lab Clin Med, 1982, 99(2): 217-230.
    [15]
    HUGENHOLTZ GC, MACRAE F, ADELMEIJER J, et al. Procoagulant changes in fibrin clot structure in patients with cirrhosis are associated with oxidative modifications of fibrinogen[J]. J Thromb Haemost, 2016, 14(5): 1054-1066. DOI: 10.1111/jth.13278.
    [16]
    GREEN G, POLLER L, THOMSON JM, et al. Association of abnormal fibrin polymerisation with severe liver disease[J]. Gut, 1977, 18(11): 909-912. DOI: 10.1136/gut.18.11.909.
    [17]
    COLUCCI M, BINETTI BM, BRANCA MG, et al. Deficiency of thrombin activatable fibrinolysis inhibitor in cirrhosis is associated with increased plasma fibrinolysis[J]. Hepatology, 2003, 38(1): 230-237. DOI: 10.1053/jhep.2003.50277.
    [18]
    RAUTOU PE, BRESSON J, SAINTE-MARIE Y, et al. Abnormal plasma microparticles impair vasoconstrictor responses in patients with cirrhosis[J]. Gastroenterology, 2012, 143(1): 166-176. e6. DOI: 10.1053/j.gastro.2012.03.040.
    [19]
    RAUTOU PE, VION AC, LUYENDYK JP, et al. Circulating microparticle tissue factor activity is increased in patients with cirrhosis[J]. Hepatology, 2014, 60(5): 1793-1795. DOI: 10.1002/hep.27033.
    [20]
    OWENS AP 3rd, MACKMAN N. Microparticles in hemostasis and thrombosis[J]. Circ Res, 2011, 108(10): 1284-1297. DOI: 10.1161/CIRCRESAHA.110.233056.
    [21]
    GOULD TJ, VU TT, SWYSTUN LL, et al. Neutrophil extracellular traps promote thrombin generation through platelet-dependent and platelet-independent mechanisms[J]. Arterioscler Thromb Vasc Biol, 2014, 34(9): 1977-1984. DOI: 10.1161/ATVBAHA.114.304114.
    [22]
    AGRAZ-CIBRIAN JM, SEGURA-ORTEGA JE, DELGADO-RIZO V, et al. Alterations in neutrophil extracellular traps is associated with the degree of decompensation of liver cirrhosis[J]. J Infect Dev Ctries, 2016, 10(5): 512-517. DOI: 10.3855/jidc.7165.
    [23]
    BLASI A, PATEL VC, ADELMEIJER J, et al. Plasma levels of circulating DNA are associated with outcome, but not with activation of coagulation in decompensated cirrhosis and ACLF[J]. JHEP Rep, 2019, 1(3): 179-187. DOI: 10.1016/j.jhepr.2019.06.002.
    [24]
    STINE JG, WANG J, SHAH PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case-control study[J]. Liver Int, 2018, 38(1): 94-101. DOI: 10.1111/liv.13500.
    [25]
    QUECK A, CARNEVALE R, USCHNER FE, et al. Role of portal venous platelet activation in patients with decompensated cirrhosis and TIPS[J]. Gut, 2020, 69(8): 1535-1536. DOI: 10.1136/gutjnl-2019-319044.
    [26]
    DELAHOUSSE B, LABAT-DEBELLEIX V, DECALONNE L, et al. Comparative study of coagulation and thrombin generation in the portal and jugular plasma of patients with cirrhosis[J]. Thromb Haemost, 2010, 104(4): 741-749. DOI: 10.1160/TH10-01-0040.
    [27]
    SHOJAEI S, TAFAZZOLI-SHADPOUR M, SHOKRGOZAR MA, et al. Stress phase angle regulates differentiation of human adipose-derived stem cells toward endothelial phenotype[J]. Prog Biomater, 2018, 7(2): 121-131. DOI: 10.1007/s40204-018-0090-5.
    [28]
    CARNEVALE R, RAPARELLI V, NOCELLA C, et al. Gut-derived endotoxin stimulates factor Ⅷ secretion from endothelial cells. Implications for hypercoagulability in cirrhosis[J]. J Hepatol, 2017, 67(5): 950-956. DOI: 10.1016/j.jhep.2017.07.002.
    [29]
    SHALABY S, SIMIONI P, CAMPELLO E, et al. Endothelial damage of the portal vein is associated with heparin-like effect in advanced stages of cirrhosis[J]. Thromb Haemost, 2020, 120(8): 1173-1181. DOI: 10.1055/s-0040-1713169.
    [30]
    TRIPODI A, MANNUCCI PM. The coagulopathy of chronic liver disease[J]. N Engl J Med, 2011, 365(2): 147-156. DOI: 10.1056/NEJMra1011170.
    [31]
    ALI M, ANANTHAKRISHNAN AN, MCGINLEY EL, et al. Deep vein thrombosis and pulmonary embolism in hospitalized patients with cirrhosis: A nationwide analysis[J]. Dig Dis Sci, 2011, 56(7): 2152-2159. DOI: 10.1007/s10620-011-1582-5.
    [32]
    QI X, REN W, GUO X, et al. Epidemiology of venous thromboembolism in patients with liver diseases: A systematic review and meta-analysis[J]. Intern Emerg Med, 2015, 10(2): 205-217. DOI: 10.1007/s11739-014-1163-7.
    [33]
    INTAGLIATA NM, CALDWELL SH, TRIPODI A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis[J]. Gastroenterology, 2019, 156(6): 1582-1599. e1. DOI: 10.1053/j.gastro.2019.01.265.
    [34]
    UNGPRASERT P, WIJARNPREECHA K, THONGPRAYOON C. Risk of cerebrovascular accident in patients with primary biliary cirrhosis: A systematic review and meta-analysis[J]. Eur J Gastroenterol Hepatol, 2016, 28(1): 90-94. DOI: 10.1097/MEG.0000000000000493.
    [35]
    ZHENG K, YOSHIDA EM, TACKE F, et al. Risk of stroke in liver cirrhosis: A systematic review and meta-analysis[J]. J Clin Gastroenterol, 2020, 54(1): 96-105. DOI: 10.1097/MCG.0000000000001201.
    [36]
    XIONG J, XU W, HUANG H, et al. Cirrhosis and risk of stroke: A systematic review and meta-analysis[J]. Atherosclerosis, 2018, 275: 296-303. DOI: 10.1016/j.atherosclerosis.2018.06.876.
    [37]
    STINE JG, SHAH PM, CORNELLA SL, et al. Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: A meta-analysis[J]. World J Hepatol, 2015, 7(27): 2774-2780. DOI: 10.4254/wjh.v7.i27.2774.
    [38]
    Hepatobiliary Disease Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus for management of portal vein thrombosis in liver cirrhosis(2020, Shanghai)[J]. J Clin Hepatol, 2020, 36(12): 2667-2674. DOI: 10.3969/j.issn.1001-5256.2020.12.007.

    中华医学会消化病学分会肝胆疾病学组. 肝硬化门静脉血栓管理专家共识(2020年, 上海)[J]. 临床肝胆病杂志, 2020, 36(12): 2667-2674. DOI: 10.3969/j.issn.1001-5256.2020.12.007.
    [39]
    BOS S, van DEN BOOM B, KAMPHUISEN PW, et al. Haemostatic profiles are similar across all aetiologies of cirrhosis[J]. Thromb Haemost, 2019, 119(2): 246-253. DOI: 10.1055/s-0038-1676954.
    [40]
    OZER B, SERIN E, SEZGIN N, et al. Thrombopoietin or interleukin-6 has no effect on thrombocytopenia of cirrhosis[J]. Hepatogastroenterology, 2007, 54(76): 1187-1191. http://europepmc.org/abstract/MED/17629067
    [41]
    MANGIA A, MARGAGLIONE M, CASCAVILLA I, et al. Anticardiolipin antibodies in patients with liver disease[J]. Am J Gastroenterol, 1999, 94(10): 2983-2987. DOI: 10.1111/j.1572-0241.1999.01447.x.
    [42]
    LI SJ, WANG L, CHEN Z, et al. Association of genotype with cellular immunity and coagulation function in chronic hepatitis B virus infection patients with different disease spectrums in Sichuan, China[J]. J Clin Hepatol, 2020, 36(5): 1014-1018. DOI: 10.3969/j.issn.1001-5256.2020.05.013.

    李守娟, 王丽, 陈竹, 等. 四川地区不同疾病谱慢性HBV感染者病毒基因分型与细胞免疫及凝血功能的关系[J]. 临床肝胆病杂志, 2020, 36(5): 1014-1018. DOI: 10.3969/j.issn.1001-5256.2020.05.013.
    [43]
    XU Y, HUANG XP, CHEN L, et al. Role of coagulation abnormalities in thrombosis in patients with hepatitis B virus-associated acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(3): 560-564. DOI: 10.3969/j.issn.1001-5256.2021.03.012.

    徐英, 黄小平, 陈丽, 等. 凝血异常在HBV相关慢加急性肝衰竭患者血栓形成中的作用[J]. 临床肝胆病杂志, 2021, 37(3): 560-564. DOI: 10.3969/j.issn.1001-5256.2021.03.012.
    [44]
    GIANNINI EG, STRAVITZ RT, CALDWELL SH. Correction of hemostatic abnormalities and portal pressure variations in patients with cirrhosis[J]. Hepatology, 2014, 60(4): 1442. DOI: 10.1002/hep.27029.
    [45]
    TRIPODI A, SALERNO F, CHANTARANGKUL V, et al. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests[J]. Hepatology, 2005, 41(3): 553-558. DOI: 10.1002/hep.20569.
    [46]
    TALON L, SINEGRE T, LECOMPTE T, et al. Hypercoagulability (thrombin generation) in patients with cirrhosis is detected with ST-Genesia[J]. J Thromb Haemost, 2020, 18(9): 2177-2190. DOI: 10.1111/jth.14963.
    [47]
    CAI TT, LI TX, ZENG W, et al. Study on emergency blood transfusion strategy for traumatic hemorrhagic shock[J]. Trauma Crit Med, 2021, 9(2): 128-131. DOI: 10.16048/j.issn.2095-5561.2021.02.11

    蔡婷婷, 李天星, 曾文, 等. 血栓弹力图指导创伤失血性休克急诊输血策略研究[J]. 创伤与急危重病医学, 2021, 9(2): 128-131. DOI: 10.16048/j.issn.2095-5561.2021.02.11.
    [48]
    COPPELL JA, THALHEIMER U, ZAMBRUNI A, et al. The effects of unfractionated heparin, low molecular weight heparin and danaparoid on the thromboelastogram (TEG): An in-vitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays[J]. Blood Coagul Fibrinolysis, 2006, 17(2): 97-104. DOI: 10.1097/01.mbc.0000203859.62739.25.
    [49]
    DE PIETRI L, BIANCHINI M, MONTALTI R, et al. Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial[J]. Hepatology, 2016, 63(2): 566-573. DOI: 10.1002/hep.28148.
    [50]
    KUMAR M, AHMAD J, MAIWALL R, et al. Thromboelastography-guided blood component use in patients with cirrhosis with nonvariceal bleeding: A randomized controlled trial[J]. Hepatology, 2020, 71(1): 235-246. DOI: 10.1002/hep.30794.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索
    Get Citation
    PDF
    XML

    Article Metrics

    Article views (825) PDF downloads(111) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return