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[The mechanisms of disorders in the hemostatic system of patients with chronic diffuse liver diseases]
Insights
Chronic liver diseases cause complex hemostatic system impairments. Local intravascular coagulation (LIC) in the liver increases bleeding risk, while systemic hypocoagulation can lead to hemorrhagic syndrome (HS).
Area of Science:
- Hepatology
- Hematology
- Pathophysiology
Background:
- Chronic diffuse liver diseases, including chronic hepatitis and liver cirrhosis, are associated with significant hemostatic disturbances.
- Hemorrhagic syndrome (HS) is a recognized complication, particularly in advanced liver disease.
Purpose of the Study:
- To investigate the complex impairments of the hemostatic system in patients with chronic diffuse liver diseases.
- To elucidate the mechanisms underlying hemorrhagic syndrome and thrombosis risk in these patients.
Main Methods:
- Intravital study of intravascular blood coagulation and liver microcirculation.
- Fibrin determination using a specific method.
- Analysis of hemostatic and fibrinolytic systems, liver function, and hemocoagulation.
- Assessment of local intravascular coagulation (LIC-syndrome) intensity.
Main Results:
- Hemorrhagic syndrome (HS) prevalence increased with disease severity: 16% in chronic active hepatitis, 26% in compensated liver cirrhosis (LC), and 76% in decompensated LC.
- Patients exhibited systemic hypocoagulation with HS risk and hepatic hypercoagulation with thrombosis risk.
- Thrombocytopenia, due to hypersplenism and platelet consumption in LIC, was identified as the primary cause of HS.
- Activated fibrinolysis inhibited hemocoagulation in decompensated LC but had minimal impact on HS in compensated hepatopathies.
Conclusions:
- Complex hemostatic system derangements characterize chronic diffuse liver diseases.
- The interplay between systemic hypocoagulation and hepatic hypercoagulation contributes to bleeding and thrombosis risks.
- Thrombocyte dysfunction is a key factor in the pathogenesis of hemorrhagic syndrome in these conditions.
Abstract:
A total of 70 patients with chronic hepatitis and 60 with liver cirrhosis (LC) were examined. The hemorrhagic syndrome (HS) was identified in 16% of patients with chronic active hepatitis, in 26% with compensated and in 76% with decompensated LC. Intravital study of intravascular blood coagulation and liver microcirculation with the aid of fibrin determination according to D. D. Zerbino made it possible to establish local intravascular coagulation (LIC-syndrome). Study into the hemostatic and fibrinolytic systems, analysis of liver function, hemocoagulation and the intensity of the LIC-syndrome permitted one to arrive at conclusions about complex impairments of the hemostatic system in patients with chronic diffuse liver diseases characterized by a tendency towards blood hypocoagulation in the systemic blood flow with the risk of the development of the HS and a tendency towards hypercoagulation (with the risk of thrombosis development) in the vascular bed of the liver. It has been shown that the main cause of the HS occurring in chronic diffuse liver diseases lies in derangements of the thrombocytic component of the hemostatic system: thrombocytopenia as a consequence of hypersplenism and consumption of the most active thrombocytes in the process of the LIC. Activated fibrinolysis starts to exert an inhibitory action on hemocoagulation in patients with chronic diffuse liver diseases in the stage of decompensated LC. In compensated hepatopathies, the influence of fibrinolysis on coagulation and the development of the HS was immaterial.