Coagulopathy in liver disease

被引：36
作者：
Blonski W. [1 ]
Siropaides T. [1 ]
Reddy K.R. [1 ]
机构：
[1] Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
来源：
Current Treatment Options in Gastroenterology | 2007年 / 10卷 / 6期
关键词：
Liver Disease; International Normalize Ratio; Chronic Liver Disease; Disseminate Intravascular Coagulation; Orthotopic Liver Transplantation;
D O I：
10.1007/s11938-007-0046-7
中图分类号：
学科分类号：
摘要：
The liver plays a central role in hemostasis, as it is the site of synthesis of clotting factors, coagulation inhibitors, and fibrinolytic proteins. The most common coagulation disturbances occurring in liver disease include thrombocytopenia and impaired humoral coagulation. Therapy's overall goal is not to achieve complete correction of laboratory value abnormalities but to gain hemostasis. Therapy with vitamin K may be a useful option in patients with increased prothrombin time due to vitamin K deficiency; in patients with malnutrition; in patients using antibiotics; and in patients with cholestatic liver disease, particularly prior to invasive procedures. Infusion of fresh frozen plasma is more often effective and is recommended in patients with liver disease before invasive procedures or surgery, as such patients require transient correction in their prothrombin time. Therapy with plasma exchange may be considered in patients who cannot be treated with fresh frozen plasma due to volume overload risk. In patients with severe coagulopathy and hypofibrinogenemia, cryoprecipitate therapy is ideal. Therapy with prothrombin-complex concentrate is seldom pursued in patients with liver disease due to high risk of thrombotic complications. Transfusions of platelets are appropriate for patients with thrombocytopenia (< 50,000/mm3) associated with active bleeding or before invasive procedures in which a short-term platelet count increase is noted. Trial with desmopressin may be considered before invasive procedures in patients with liver disease and with refractory and prolonged bleeding time. Recombinant activated factor VIIa administration is suggested for patients with significantly prolonged prothrombin time and contraindications to fresh frozen plasma therapy; however, this is expensive. Thrombopoietin and interleukin-11 are currently investigational for patients with thrombocytopenia of chronic liver disease. Liver transplantation completely restores impaired coagulation abnormalities and is the ultimate intervention that corrects coagulopathy of advanced liver disease and liver failure. Copyright © 2007 by Current Medicine Group LLC.
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页码：464 / 473
页数：9
相关论文
共 41 条
  • [1] Kujovich J.L., Hemostatic defects in end stage liver disease, Crit Care Clin, 21, pp. 563-587, (2005)
  • [2] Trotter J.F., Coagulation abnormalities in patients who have liver disease, Clin Liver Dis, 10, (2006)
  • [3] Braunwald E., Fauci A.S., Kasper D., Et al., Harrison's Principles of Internal Medicine, (2001)
  • [4] Aref S., Mabed M., Selim T., Et al., Thrombopoietin (TPO) levels in hepatic patients with thrombocytopenia, Hematology, 9, pp. 351-356, (2004)
  • [5] Koruk M., Onuk M.D., Akcay F., Et al., Serum thrombopoietin levels in patients with chronic hepatitis and liver cirrhosis, and its relationship with circulating thrombocyte counts, Hepatogastroenterology, 49, pp. 1645-1648, (2002)
  • [6] Peck-Radosavljevic M., Thrombocytopenia in liver disease, Can J Gastroenterol, 14, SUPPL. D, (2000)
  • [7] Kim W.R., Brown Jr R.S., Terrault N.A., Et al., Burden of liver disease in the United States: Summary of a workshop, Hepatology, 36, pp. 227-242, (2002)
  • [8] Amitrano L., Guardascione M.A., Brancaccio V., Et al., Coagulation disorders in liver disease, Semin Liver Dis, 22, pp. 83-96, (2002)
  • [9] Lisman T., Leebeek F.W., de Groot P.G., Haemostatic abnormalities in patients with liver disease, J Hepatol, 37, pp. 280-287, (2002)
  • [10] Beers M., Berkow R., The Merck Manual of Diagnosis and Therapy, (1999)
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