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Anticoagulation in the cirrhotic patient

Laura Turco1,2, Emmanuelle de Raucourt3, Dominique-Charles Valla4

  • 1Department of Gastroenterology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Italy.

JHEP Reports : Innovation in Hepatology
|February 11, 2020
PubMed

Insights

Patients with liver cirrhosis face higher risks of blood clots than bleeding. Anticoagulation therapy, including new oral anticoagulants, improves outcomes and survival in these patients.

Area of Science:

  • Hepatology
  • Hematology
  • Clinical Medicine

Background:

  • Historically, liver cirrhosis was associated with bleeding risks.
  • Compensated cirrhosis exhibits normal coagulation, but decompensation can alter this balance.
  • Current understanding indicates a shift towards thrombotic risks in advanced liver cirrhosis.

Purpose of the Study:

  • To review the evolving understanding of coagulation in liver cirrhosis.
  • To evaluate the role and safety of anticoagulation in liver cirrhosis patients.
  • To assess the potential of novel oral anticoagulants in this population.

Main Methods:

  • Literature review of studies on coagulation and anticoagulation in liver cirrhosis.
  • Analysis of clinical outcomes associated with anticoagulation therapy.
  • Examination of preliminary data on novel oral anticoagulants.

Main Results:

  • Patients with liver cirrhosis are now recognized to have a higher risk of thrombosis.
  • Anticoagulation, both therapeutic and prophylactic, is linked to reduced decompensation and improved survival.
  • Established anticoagulants include low molecular weight heparins and vitamin K antagonists.

Conclusions:

  • Anticoagulation is beneficial in managing thrombotic risks in liver cirrhosis.
  • Novel non-vitamin K antagonist oral anticoagulants show promise for safe use in liver cirrhosis.
  • Further research is warranted to confirm the safety and efficacy of novel anticoagulants.

Keywords:
Chronic liver diseaseCoagulopathyDecompensationPortal HypertensionThrombophilia

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