The Spectrum of Disease Severity in Cirrhosis and Its Implications for Hemostasis

Matthew J. Stotts*, Ton Lisman, Nicolas M. Intagliata

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Bleeding and thrombosis are both common complications that patients with advanced liver disease experience. While hemostatic pathways remain largely intact with cirrhosis, this balance can quickly shift in the direction of bleeding or clotting in an unpredictable manner. A growing body of literature is attempting to shed light on difficult scenarios that clinicians often face, ranging from predicting and mitigating bleeding risk in those who need invasive procedures to determining the best strategies to manage both bleeding and thrombotic complications when they occur. Studies examining hemostasis in those with advanced liver disease, however, often include heterogeneous cohorts with varied methodology. While these studies often select a cohort of all types and degrees of cirrhosis, emerging evidence suggests significant differences in underlying systemic inflammation and hemostatic abnormalities among specific phenotypes of liver disease, ranging from compensated cirrhosis to decompensated cirrhosis and acute-on-chronic liver failure. It is paramount that future studies account for these differing disease severities if we hope to address the many critical knowledge gaps in this field.

Original languageEnglish
Pages (from-to)716-723
Number of pages8
JournalSeminars in thrombosis and hemostasis
Volume46
Issue number6
DOIs
Publication statusE-pub ahead of print - 20-Aug-2020

Keywords

  • coagulation
  • hemostasis
  • cirrhosis
  • acute-on-chronic liver failure
  • CHRONIC LIVER-FAILURE
  • PORTAL-VEIN THROMBOSIS
  • VITAMIN-K ANTAGONIST
  • ATRIAL-FIBRILLATION
  • INVASIVE PROCEDURES
  • MODEL
  • SURVIVAL
  • MELD
  • ANTICOAGULANTS
  • DECOMPENSATION

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