中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 9
Sep.  2022
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(9): 2141-2145

Mechanism of rebalanced hemostasis in liver cirrhosis and the timing of blood transfusion and anticoagulation

DOI: 10.3969/j.issn.1001-5256.2022.09.037

  • Department of Gastroenterology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China

Research funding:

National Natural Science Foundation of China (82100620);

Doctoral Startup Reasearch Fund of Liaoning Province (2021-BS-218);

Dalian Medical Science Research Program Project (2112015)

More Information
  • Corresponding author: LIU Hui, liuhuidoctor@dmu.edu.cn(ORCID: 0000-0003-4721-560X)
  • Received Date: 2022-02-14
  • Accepted Date: 2022-03-20
  • Published Date: 2022-09-20
    Abstract
  • Reconstructed rebalanced hemostasis exists in patients with liver cirrhosis, while such balance is unstable and can be easily broken by stress factors, which may lead to bleeding or thrombosis. There is a lack of effective strategies to prevent and solve the disrupted balance in clinic due to the complex pathogenesis of rebalanced hemostasis, limited testing methods, and insufficient awareness among clinicians. With reference to the articles in recent years, this article summarizes the mechanism of rebalanced hemostasis in liver cirrhosis and the causes of bleeding and thrombosis and discuss the association between blood transfusion and rebalanced hemostasis and the selection of anticoagulant drugs during thrombosis, in order to provide a theoretical basis and new ideas for solving related issues in clinical practice.

     

    • FullText(HTML)
  • loading
    • References(45)
  • [1]
    TRIPODI A. Hemostasis abnormalities in cirrhosis[J]. Curr Opin Hematol, 2015, 22(5): 406-412. DOI: 10.1097/MOH.0000000000000164.
    [2]
    LISMAN T, PORTE RJ. Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences[J]. Blood, 2010, 116(6): 878-885. DOI: 10.1182/blood-2010-02-261891.
    [3]
    MCMURRY HS, JOU J, SHATZEL J. The hemostatic and thrombotic complications of liver disease[J]. Eur J Haematol, 2021, 107(4): 383-392. DOI: 10.1111/ejh.13688.
    [4]
    AREF S, MABED M, SELIM T. Thrombopoietin (TPO) levels in hepatic patients with thrombocytopenia[J]. Hematology, 2004, 9(5-6): 351-356. DOI: 10.1080/10245330400010620.
    [5]
    ZERMATTEN MG, FRAGA M, MORADPOUR D, et al. Hemostatic alterations in patients with cirrhosis: From primary hemostasis to fibrinolysis[J]. Hepatology, 2020, 71(6): 2135-2148. DOI: 10.1002/hep.31201.
    [6]
    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.
    [7]
    KUJOVICH JL. Coagulopathy in liver disease: a balancing act[J]. Hematology Am Soc Hematol Educ Program, 2015, 2015: 243-249. DOI: 10.1182/asheducation-2015.1.243.
    [8]
    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.
    [9]
    DONG JF, MOAKE JL, NOLASCO L, et al. ADAMTS-13 rapidly cleaves newly secreted ultralarge von Willebrand factor multimers on the endothelial surface under flowing conditions[J]. Blood, 2002, 100(12): 4033-4039. DOI: 10.1182/blood-2002-05-1401.
    [10]
    FENG Y, LI X, XIAO J, et al. ADAMTS13: more than a regulator of thrombosis[J]. Int J Hematol, 2016, 104(5): 534-539. DOI: 10.1007/s12185-016-2091-2.
    [11]
    SINEGRE T, DURON C, LECOMPTE T, et al. Increased factor Ⅷ plays a significant role in plasma hypercoagulability phenotype of patients with cirrhosis[J]. J Thromb Haemost, 2018, 16(6): 1132-1140. DOI: 10.1111/jth.14011.
    [12]
    INTAGLIATA NM, DAVIS J, CALDWELL SH. Coagulation pathways, hemostasis, and thrombosis in liver failure[J]. Semin Respir Crit Care Med, 2018, 39(5): 598-608. DOI: 10.1055/s-0038-1673658.
    [13]
    TRIPODI A, PRIMIGNANI M, MANNUCCI PM, et al. Changing concepts of cirrhotic coagulopathy[J]. Am J Gastroenterol, 2017, 112(2): 274-281. DOI: 10.1038/ajg.2016.498.
    [14]
    WU X, YAO Z, ZHAO L, et al. Phosphatidylserine on blood cells and endothelial cells contributes to the hypercoagulable state in cirrhosis[J]. Liver Int, 2016, 36(12): 1800-1810. DOI: 10.1111/liv.13167.
    [15]
    LIAW PC, ITO T, IBA T, et al. DAMP and DIC: The role of extracellular DNA and DNA-binding proteins in the pathogenesis of DIC[J]. Blood Rev, 2016, 30(4): 257-261. DOI: 10.1016/j.blre.2015.12.004.
    [16]
    CHAPIN JC, HAJJAR KA. Fibrinolysis and the control of blood coagulation[J]. Blood Rev, 2015, 29(1): 17-24. DOI: 10.1016/j.blre.2014.09.003.
    [17]
    RIJKEN DC, KOCK EL, GUIMARÃES AH, et al. Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests[J]. J Thromb Haemost, 2012, 10(10): 2116-2122. DOI: 10.1111/j.1538-7836.2012.04901.x.
    [18]
    FERRO D, CELESTINI A, VIOLI F. Hyperfibrinolysis in liver disease[J]. Clin Liver Dis, 2009, 13(1): 21-31. DOI: 10.1016/j.cld.2008.09.008.
    [19]
    PECK-RADOSAVLJEVIC M. Thrombocytopenia in chronic liver disease[J]. Liver Int, 2017, 37(6): 778-793. DOI: 10.1111/liv.13317.
    [20]
    RODRÍGUEZ-CASTRO KI, ANTONELLO A, FERRARESE A. Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most?[J]. World J Hepatol, 2015, 7(14): 1818-1827. DOI: 10.4254/wjh.v7.i14.1818.
    [21]
    TRIPODI A, ANSTEE QM, SOGAARD KK, et al. Hypercoagulability in cirrhosis: causes and consequences[J]. J Thromb Haemost, 2011, 9(9): 1713-1723. DOI: 10.1111/j.1538-7836.2011.04429.x.
    [22]
    MA SD, WANG J, BEZINOVER D, et al. Inherited thrombophilia and portal vein thrombosis in cirrhosis: A systematic review and meta-analysis[J]. Res Pract Thromb Haemost, 2019, 3(4): 658-667. DOI: 10.1002/rth2.12253.
    [23]
    ZHAN XL, JI Y, WANG YD. Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension[J]. World J Gastroenterol, 2014, 20(19): 5794-5800. DOI: 10.3748/wjg.v20.i19.5794.
    [24]
    WU Y, LI H, ZHANG T, et al. Splanchnic vein thrombosis in liver cirrhosis after splenectomy or splenic artery embolization: A systematic review and meta-analysis[J]. Adv Ther, 2021, 38(4): 1904-1930. DOI: 10.1007/s12325-021-01652-7.
    [25]
    HUANG D, TAO M, CAO L, et al. Risk factors and anticoagulation effects of portal vein system thrombosis after laparoscopic splenectomy in patients with or without cirrhosis[J]. Surg Laparosc Endosc Percutan Tech, 2019, 29(6): 498-502. DOI: 10.1097/SLE.0000000000000710.
    [26]
    STRAVITZ RT. Algorithms for managing coagulation disorders in liver disease[J]. Hepatol Int, 2018, 12(5): 390-401. DOI: 10.1007/s12072-018-9886-6.
    [27]
    LEBRETON A, SINEGRE T, LECOMPTE T, et al. Thrombin generation and cirrhosis: state of the art and perspectives[J]. Semin Thromb Hemost, 2020, 46(6): 693-703. DOI: 10.1055/s-0040-1715102.
    [28]
    SCHARF RE. Thrombocytopenia and hemostatic changes in acute and chronic liver disease: pathophysiology, clinical and laboratory features, and management[J]. J Clin Med, 2021, 10(7): 1530. DOI: 10.3390/jcm10071530.
    [29]
    ROBERTS LN, PATEL RK, ARYA R. Haemostasis and thrombosis in liver disease[J]. Br J Haematol, 2010, 148(4): 507-521. DOI: 10.1111/j.1365-2141.2009.08021.x.
    [30]
    THAI C, OBEN C, WAGENER G. Coagulation, hemostasis, and transfusion during liver transplantation[J]. Best Pract Res Clin Anaesthesiol, 2020, 34(1): 79-87. DOI: 10.1016/j.bpa.2020.03.002.
    [31]
    O'SHEA RS, DAVITKOV P, KO CW, et al. AGA clinical practice guideline on the management of coagulation disorders in patients with cirrhosis[J]. Gastroenterology, 2021, 161(5): 1615-1627. e1. DOI: 10.1053/j.gastro.2021.08.015.
    [32]
    VON MEIJENFELDT FA, VAN DEN BOOM BP, ADELMEIJER J, et al. Prophylactic fresh frozen plasma and platelet transfusion have a prothrombotic effect in patients with liver disease[J]. J Thromb Haemost, 2021, 19(3): 664-676. DOI: 10.1111/jth.15185.
    [33]
    LIU P, HUM J, JOU J, et al. Transfusion strategies in patients with cirrhosis[J]. Eur J Haematol, 2020, 104(1): 15-25. DOI: 10.1111/ejh.13342.
    [34]
    RASSI AB, D'AMICO EA, TRIPODI A, et al. Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation[J]. J Hepatol, 2020, 72(1): 85-94. DOI: 10.1016/j.jhep.2019.09.008.
    [35]
    DROLZ A, HORVATITS T, ROEDL K, et al. Coagulation parameters and major bleeding in critically ill patients with cirrhosis[J]. Hepatology, 2016, 64(2): 556-568. DOI: 10.1002/hep.28628.
    [36]
    PANT A, KOPEC AK, LUYENDYK JP. Role of the blood coagulation cascade in hepatic fibrosis[J]. Am J Physiol Gastrointest Liver Physiol, 2018, 315(2): G171-G176. DOI: 10.1152/ajpgi.00402.2017.
    [37]
    FLORES B, TRIVEDI HD, ROBSON SC, et al. Hemostasis, bleeding and thrombosis in liver disease[J]. J Transl Sci, 2017, 3(3): 10.15761/JTS. 1000182. DOI: 10.15761/JTS.1000182.
    [38]
    WITT DM, CLARK NP, KAATZ S, et al. Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism[J]. J Thromb Thrombolysis, 2016, 41(1): 187-205. DOI: 10.1007/s11239-015-1319-y.
    [39]
    INTAGLIATA NM, HENRY ZH, MAITLAND H, et al. Direct oral anticoagulants in cirrhosis patients pose similar risks of bleeding when compared to traditional anticoagulation[J]. Dig Dis Sci, 2016, 61(6): 1721-1727. DOI: 10.1007/s10620-015-4012-2.
    [40]
    DE GOTTARDI A, TREBICKA J, KLINGER C, et al. Antithrombotic treatment with direct-acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis[J]. Liver Int, 2017, 37(5): 694-699. DOI: 10.1111/liv.13285.
    [41]
    CHUN HS, CHOE AR, LEE M, et al. Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis[J]. Clin Mol Hepatol, 2021, 27(4): 535-552. DOI: 10.3350/cmh.2021.0109.
    [42]
    LEONARDI F, MARIA N, VILLA E. Anticoagulation in cirrhosis: a new paradigm?[J]. Clin Mol Hepatol, 2017, 23(1): 13-21. DOI: 10.3350/cmh.2016.0110.
    [43]
    ZHANG N, YAO Y, XUE W, et al. Early prophylactic anticoagulation for portal vein system thrombosis after splenectomy: A systematic review and meta-analysis[J]. Biomed Rep, 2016, 5(4): 483-490. DOI: 10.3892/br.2016.755.
    [44]
    KAWANAKA H, AKAHOSHI T, KINJO N, et al. Impact of antithrombin Ⅲ concentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism[J]. Ann Surg, 2010, 251(1): 76-83. DOI: 10.1097/SLA.0b013e3181bdf8ad.
    [45]
    GONG C, QIN X, YANG J, et al. The best anticoagulation strategy for cirrhotic patients who underwent splenectomy: A network meta-analysis[J]. Gastroenterol Res Pract, 2017, 2017: 9216172. DOI: 10.1155/2017/9216172.
    • 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 (513) PDF downloads(62) 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