[Coagulation and cirrhosis: new insight]

Area of Science:

• Hepatology
• Hematology
• Coagulation Science

Context:

• Liver cirrhosis alters hepatic synthesis of clotting factors and inhibitors.
• Routine coagulation tests in cirrhosis may not accurately reflect the hemostatic balance.
• Cirrhotic patients exhibit a paradoxical risk of thrombosis despite decreased procoagulant factors.

Purpose:

• To elucidate the complex hemostatic balance in liver cirrhosis.
• To highlight the limitations of routine coagulation tests in cirrhotic patients.
• To explain the underlying reasons for the thrombotic risk in cirrhosis.

Summary:

• Hepatocytes synthesize most clotting factors; liver cirrhosis reduces these factors and platelets.
• A concurrent decrease in coagulation inhibitors is not detected by standard tests.
• The cirrhotic coagulation system is a balance of pro- and anticoagulant factors, susceptible to co-factors like infection or renal failure.

Impact:

• Understanding the true hemostatic state in cirrhosis is crucial for patient management.
• Routine laboratory values can be misleading, suggesting bleeding risk when thrombotic risk prevails.
• Inappropriate transfusion of blood products can lead to adverse events like volume overload and transfusion-related acute lung injury (TRALI).