Pathophysiology and management of hemostatic alterations in cirrhosis and liver transplantation

Freeha Arshad

    Research output: ThesisThesis fully internal (DIV)

    850 Downloads (Pure)

    Abstract

    In this thesis the results of several studies on the hemostasis prior to, during, and after OLT are discussed.
    Our studies show that various drugs and test work differently in patients with cirrhosis as compared to control groups. DDAVP has no effect on indices of hemostasis in contrast to patients with hemophilia type A, questioning its use as prohemostatic agent in cirrhotic patients. Various anticoagulant drug differ in efficacy as compared to healthy volunteers, indication dose adjustments in cirrhotic patients. Also, conventional coagulation assays are not reliable in measuring the efficacy of antithrombin dependent anticoagulant drugs.
    Bleeding complications during OLT occur frequently and are linked to the hemostasis, the surgical procedure and to portal hypertension. The pathophysiology, prevention and treatment of blood loss during OLT is discussed. Also we describe the study protocol of the PROTON-study, in which the hemostatic efficacy and safety of Cofact in decreasing blood loss during OLT is investigated. Retrospective research has revealed that blood loss and transfusion requirements during OLT have increased since discontinuation of prophylactic antifibrinolytic medication, prompting reconsideration of antifibrinolytic therapy during OLT. Also the role of hypertension in blood loss is confirmed in a study in which serum markers for portal hypertension prior to OLT were measured.
    Evidence for hypercoagulability in the liver transplant recipient is summarized and discussed. One year after OLT we found increased levels of endothelial derived coagulation factors, indicating the need for anticoagulant therapy in liver transplant recipients.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Porte, Robert, Supervisor
    • Lisman, Ton, Supervisor
    • de Boer, Marieke, Co-supervisor
    • Smet ,de, Anne-Marie, Assessment committee
    • Pirenne, Jacques, Assessment committee, External person
    • Meijer, K., Assessment committee, External person
    Award date7-Sep-2016
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-6169-908-4
    Electronic ISBNs978-94-6169-924-4
    Publication statusPublished - 2016

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