Cirrhotic coagulopathy: A rebalanced hemostasis.

Achintya D Singh, Simon R Mucha, Christina C Lindenmeyer

Journal: Cleveland Clinic journal of medicine 2023;89(9):523-533

PMID: 37907441

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Abstract

Cirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic complications, challenging this dogma. We now recognize that in cirrhosis there is a simultaneous decrease in both clotting and anticlotting factors, leading to a new equilibrium. Conventional coagulation tests such as the platelet count and prothrombin time do not assess the reduced anticoagulation factors in cirrhosis and overestimate the bleeding risk, and any intervention based on these test results can lead to thrombotic complications. This article reviews the changes in hemostasis associated with cirrhosis, newer tests for assessing coagulation, and preprocedural minimization of coagulopathy.

Address: Department of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.; Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic.; Clinical Instructor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.; Co-director, Cleveland Clinic Medical Intensive Liver Unit, Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH [email protected].; Associate Director of Basic Science Education, and Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH [email protected].

DOI: 10.3949/ccjm.89a.21018

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https://www.ccjm.org/lookup/pmidlookup?view=long&p...

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https://medlineplus.gov/bleedingdisorders.html

MeSH Terms: Humans, Blood Coagulation Disorders, Hemostasis, Blood Coagulation, Liver Cirrhosis, Blood Coagulation Tests, Thrombosis