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Venous thromboembolism in cirrhosis

Zhineng J Yang1, Karen A Costa, Enrico M Novelli

  • 11Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|October 19, 2012
PubMed

Insights

Patients with cirrhosis face risks of bleeding and venous thromboembolic events (VTEs). This review clarifies that "autoanticoagulation" is a misnomer, highlighting the need for better VTE management in this population.

Area of Science:

  • Hepatology
  • Hematology
  • Clinical Medicine

Background:

  • Cirrhosis patients present a complex risk profile, susceptible to both bleeding and venous thromboembolic events (VTEs).
  • The notion of cirrhosis conferring protection against thrombosis due to coagulation factor deficiencies is a misconception.
  • This perceived "autoanticoagulation" can lead to underestimation of thrombotic risk in these patients.

Purpose of the Study:

  • To examine the dual risk of bleeding and VTEs in patients with cirrhosis.
  • To address the misconception of "autoanticoagulation" and its implications for thrombosis risk.
  • To review the challenges and current understanding of VTE management and anticoagulation in cirrhosis.

Main Methods:

  • Literature review focusing on VTE and anticoagulation in cirrhosis.
  • Analysis of existing data on bleeding and thrombotic risks in cirrhotic patients.
  • Examination of the concept of "autoanticoagulation" versus actual thrombotic risk.

Main Results:

  • Cirrhosis patients exhibit a significant risk for VTEs, challenging the "autoanticoagulation" theory.
  • Bleeding risk in cirrhosis complicates anticoagulation decisions.
  • Current guidelines for VTE prophylaxis and treatment in cirrhosis are lacking.

Conclusions:

  • The concept of "autoanticoagulation" in cirrhosis is inaccurate; these patients are at risk for thrombosis.
  • Managing VTE in cirrhosis is clinically challenging due to the high bleeding risk.
  • Further research into predictors of VTE is crucial for guiding anticoagulation strategies in cirrhosis.

Keywords:
anticoagulationcirrhosiscoagulopathyvenous thromboembolism

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