Coagulation and Endothelial Dysfunction Associated with NAFLD: Current Status and Therapeutic Implications

Non-alcoholic fatty liver disease (NAFLD) is closely related to insulin resistance, type 2 diabetes mellitus, and obesity. It is nowadays considered a multisystem disease with a strong association with cardiovascular disease and arterial hypertension, which interfere with changes in the coagulation system. Coagulation disorders are common in patients with hepatic impairment and are dependent on the degree of liver damage. Patients with NAFLD may have preserved overall hemostatic profile, but many studies suggest a trend toward a procoagulant state. Hypercoagulable state in NAFLD patients may even induce progression of hepatic injury. Endothelial dysfunction is present in the systemic and portal vein circulation in NAFLD patients, and platelets are being recognized as modulators of liver diseases through various mechanisms. Through a literature review, we discuss possible disorders in the coagulation cascade and fibrinolysis, endothelial dysfunction, and platelet abnormalities in patients with NAFLD. Considering the processes and mechanisms involved in the hemostatic abnormalities associated with NAFLD, directly related to liver disease or indirectly related through inflammatory processes and metabolic disorders, several potential therapeutic targets have been identified and reviewed here.