TY - JOUR
T1 - Disseminated intravascular coagulation and cirrhotic coagulopathy
T2 - overlap and differences. The current state of knowledge. Communication from the SSC of the ISTH
AU - Scarlatescu, Ecaterina
AU - Levy, Jerrold H.
AU - Moore, Hunter
AU - Thachil, Jecko
AU - Iba, Toshiaki
AU - Roberts, Lara N.
AU - Lisman, Ton
N1 - Publisher Copyright:
© 2024 International Society on Thrombosis and Haemostasis
PY - 2025/3
Y1 - 2025/3
N2 - Patients with disseminated intravascular coagulation (DIC) have decreasing plasma levels of coagulation factors and platelet counts with increased levels of D-dimer. Standard laboratory tests are used clinically to diagnose DIC and quantify the severity of the disease. In patients with cirrhosis, liver-derived plasma coagulation factor levels are reduced due to decreased hepatic synthesis, further exacerbated by extravascular redistribution of these proteins, causing prolongation of routine diagnostic coagulation tests. Platelets are often decreased in cirrhosis due to reduced production and portal hypertension, resulting in hypersplenism and sequestration. Patients with cirrhosis frequently have elevated fibrin/fibrinogen degradation product levels without having acute medical decompensation. As a result, these patients commonly meet the laboratory criteria of DIC. However, it has been debated whether laboratory-assessed DIC is present in patients with cirrhosis and if it has clinical relevance. In this communication, we review hemostatic features in cirrhosis and DIC, examine published studies that evaluate the activation of hemostasis in patients with cirrhosis, and highlight future directions for research.
AB - Patients with disseminated intravascular coagulation (DIC) have decreasing plasma levels of coagulation factors and platelet counts with increased levels of D-dimer. Standard laboratory tests are used clinically to diagnose DIC and quantify the severity of the disease. In patients with cirrhosis, liver-derived plasma coagulation factor levels are reduced due to decreased hepatic synthesis, further exacerbated by extravascular redistribution of these proteins, causing prolongation of routine diagnostic coagulation tests. Platelets are often decreased in cirrhosis due to reduced production and portal hypertension, resulting in hypersplenism and sequestration. Patients with cirrhosis frequently have elevated fibrin/fibrinogen degradation product levels without having acute medical decompensation. As a result, these patients commonly meet the laboratory criteria of DIC. However, it has been debated whether laboratory-assessed DIC is present in patients with cirrhosis and if it has clinical relevance. In this communication, we review hemostatic features in cirrhosis and DIC, examine published studies that evaluate the activation of hemostasis in patients with cirrhosis, and highlight future directions for research.
KW - chronic liver failure
KW - cirrhosis
KW - consumption coagulopathy
KW - disseminated intravascular coagulation
UR - http://www.scopus.com/inward/record.url?scp=85213962748&partnerID=8YFLogxK
U2 - 10.1016/j.jtha.2024.11.019
DO - 10.1016/j.jtha.2024.11.019
M3 - Article
C2 - 39662873
AN - SCOPUS:85213962748
SN - 1538-7933
VL - 23
SP - 1085
EP - 1106
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 3
ER -