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Published on: April 19, 2022
Hemostasis in patients with liver disease
J van der Werf1, R J Porte, T Lisman
1Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Acta Gastro-Enterologica Belgica
|February 19, 2010
Summary
Patients with liver disease have rebalanced hemostasis, not a bleeding tendency. Restricting blood transfusions and reconsidering anticoagulants may improve outcomes in liver disease and post-transplant care.
Area of Science:
- Hepatology
- Hematology
- Transplantation Medicine
Background:
- Liver disease commonly causes alterations in the hemostatic system.
- Traditionally, these changes were thought to cause bleeding, but recent data suggest a rebalanced hemostasis.
- This rebalanced system has narrower margins, increasing susceptibility to both bleeding and clotting.
Purpose of the Study:
- To evaluate the concept of rebalanced hemostasis in liver disease.
- To question the prophylactic use of blood transfusions before invasive procedures in these patients.
- To reconsider the restricted use of anticoagulants post-liver transplantation.
Main Methods:
- Review of laboratory models and clinical data on hemostasis in liver disease.
- Analysis of bleeding and thrombotic complications in patients with liver disease, including during liver transplantation.
- Evaluation of current practices regarding transfusion and anticoagulation in liver disease patients.
Main Results:
- Clinical data support rebalanced hemostasis, with decreased pro- and antihemostatic factors.
- Bleeding in liver disease is often due to non-hematological causes (e.g., esophageal varices).
- Patients with liver disease experience both bleeding and thromboembolic events (e.g., hepatic artery thrombosis).
Conclusions:
- The concept of rebalanced hemostasis challenges the notion of a primary bleeding tendency in liver disease.
- Transfusion of blood products should be restricted due to lack of proven efficacy and transfusion risks.
- Anticoagulant use in the post-transplant setting warrants reconsideration, especially concerning hepatic artery thrombosis.
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