Document Detail


Hypercoagulability in cirrhosis: causes and consequences.
MedLine Citation:
PMID:  21729237     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Decreased levels of most coagulation factors and thrombocytopenia are the main haemostatic abnormalities of cirrhosis. As a consequence, this condition was, until recently, considered as the prototype acquired coagulopathy responsible for bleeding. However, recent evidence suggests that it should, rather, be regarded as a condition associated with normal or even increased thrombin generation. The bleeding events that occur in these patients should, therefore, be explained by the superimposed conditions that frequently occur in this setting. Due to elevated levels of factor VIII (procoagulant driver) in combination with decreased protein C (anticoagulant driver), which are typically found in patients with cirrhosis, a procoagulant imbalance, defined as a partial resistance to the in vitro anticoagulant action of thrombomodulin, can be demonstrated. Whether this in vitro hypercoagulability is truly representative of what occurs in vivo remains to be established. However, the hypothesis that it may have clinical consequences is attractive and deserves attention. The possible consequences that we discuss herein include whether (i) cirrhosis is a condition associated with increased risk of venous thromboembolism or portal vein thrombosis; (ii) the hypercoagulability associated with cirrhosis has any other role outside coagulation (i.e. progression of liver fibrosis); and (iii) anticoagulation should be used in cirrhosis. Although apparently provocative, considering anticoagulation as a therapeutic option in patients with cirrhosis is now supported by a rationale of increasing strength. There may be subgroups of patients who benefit from anticoagulation to treat or prevent thrombosis and to slow hepatic fibrosis. Clinical studies are warranted to explore these therapeutic options.
Authors:
A Tripodi; Q M Anstee; K K Sogaard; M Primignani; D C Valla
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  9     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-02     Completed Date:  2012-01-16     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  1713-23     Citation Subset:  IM    
Copyright Information:
© 2011 International Society on Thrombosis and Haemostasis.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Factor VIII / metabolism
Humans
Liver Cirrhosis / blood*,  complications*,  drug therapy
Portal Vein
Protein C / metabolism
Pulmonary Embolism / blood,  etiology,  prevention & control
Risk Factors
Thrombophilia / blood*,  drug therapy,  etiology*
Venous Thromboembolism / blood,  etiology,  prevention & control
Venous Thrombosis / blood,  etiology,  prevention & control
Grant Support
ID/Acronym/Agency:
G84/6233//Medical Research Council
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Protein C; 9001-27-8/Factor VIII

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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