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Treatment of bleeding in patients with liver disease
Patients with cirrhosis frequently have complex alterations in their hemostatic system. Although routine diagnostic tests of hemostasis in cirrhosis (platelet count, prothrombin time, fibrinogen level) are suggestive of a bleeding tendency, it is now widely accepted that these tests do not reflect h...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362012/ https://www.ncbi.nlm.nih.gov/pubmed/33974330 http://dx.doi.org/10.1111/jth.15364 |
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author | Northup, Patrick G. Lisman, Ton Roberts, Lara N. |
author_facet | Northup, Patrick G. Lisman, Ton Roberts, Lara N. |
author_sort | Northup, Patrick G. |
collection | PubMed |
description | Patients with cirrhosis frequently have complex alterations in their hemostatic system. Although routine diagnostic tests of hemostasis in cirrhosis (platelet count, prothrombin time, fibrinogen level) are suggestive of a bleeding tendency, it is now widely accepted that these tests do not reflect hemostatic competence in this population. Rather, patients with cirrhosis appear to have a rebalanced hemostatic system with hypercoagulable elements. Therefore, routine correction of hemostasis laboratory values, for example by fresh frozen plasma or platelet concentrates, with the aim to avoid spontaneous or procedure‐related bleeding is not indicated as is outlined in recent clinical guidance documents. However, little guidance on how to manage patients with cirrhosis that are actively bleeding is available. Here we present three common bleeding scenarios, variceal bleeding, post‐procedural bleeding and bleeding in a critically ill cirrhosis patient, with specific management suggestions. As patients with cirrhosis generally have adequate hemostatic competence and as bleeding complications may be unrelated to hemostatic failure, prohemostatic therapy is not the first line of management in bleeding patients with cirrhosis, even in the presence of markedly abnormal platelet counts and/or prothrombin times. We provide a rationale for the restrictive approach to prohemostatic therapy in bleeding patients with cirrhosis. |
format | Online Article Text |
id | pubmed-8362012 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83620122021-08-17 Treatment of bleeding in patients with liver disease Northup, Patrick G. Lisman, Ton Roberts, Lara N. J Thromb Haemost Jth in Clinic Patients with cirrhosis frequently have complex alterations in their hemostatic system. Although routine diagnostic tests of hemostasis in cirrhosis (platelet count, prothrombin time, fibrinogen level) are suggestive of a bleeding tendency, it is now widely accepted that these tests do not reflect hemostatic competence in this population. Rather, patients with cirrhosis appear to have a rebalanced hemostatic system with hypercoagulable elements. Therefore, routine correction of hemostasis laboratory values, for example by fresh frozen plasma or platelet concentrates, with the aim to avoid spontaneous or procedure‐related bleeding is not indicated as is outlined in recent clinical guidance documents. However, little guidance on how to manage patients with cirrhosis that are actively bleeding is available. Here we present three common bleeding scenarios, variceal bleeding, post‐procedural bleeding and bleeding in a critically ill cirrhosis patient, with specific management suggestions. As patients with cirrhosis generally have adequate hemostatic competence and as bleeding complications may be unrelated to hemostatic failure, prohemostatic therapy is not the first line of management in bleeding patients with cirrhosis, even in the presence of markedly abnormal platelet counts and/or prothrombin times. We provide a rationale for the restrictive approach to prohemostatic therapy in bleeding patients with cirrhosis. John Wiley and Sons Inc. 2021-06-06 2021-07 /pmc/articles/PMC8362012/ /pubmed/33974330 http://dx.doi.org/10.1111/jth.15364 Text en © 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Jth in Clinic Northup, Patrick G. Lisman, Ton Roberts, Lara N. Treatment of bleeding in patients with liver disease |
title | Treatment of bleeding in patients with liver disease |
title_full | Treatment of bleeding in patients with liver disease |
title_fullStr | Treatment of bleeding in patients with liver disease |
title_full_unstemmed | Treatment of bleeding in patients with liver disease |
title_short | Treatment of bleeding in patients with liver disease |
title_sort | treatment of bleeding in patients with liver disease |
topic | Jth in Clinic |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362012/ https://www.ncbi.nlm.nih.gov/pubmed/33974330 http://dx.doi.org/10.1111/jth.15364 |
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