[Coagulation disorders in liver cirrhosis - Diagnostics and management]

Area of Science:

• Hepatology
• Hematology
• Clinical Coagulation

Background:

• Liver cirrhosis causes intricate hemostatic system changes, leading to bleeding and thrombotic risks.
• Compensated cirrhosis may present a rebalanced hemostatic state, while decompensation destabilizes this equilibrium.
• Conventional coagulation tests are insufficient for assessing cirrhosis-related hemostatic complexity.

Purpose of the Study:

• To review the pathophysiological changes in the hemostatic system in liver cirrhosis.
• To provide an overview of diagnostic methods for evaluating coagulation status.
• To discuss therapeutic strategies for bleeding and thrombotic complications in cirrhosis.

Main Methods:

• Literature review of pathophysiological changes in hemostasis in liver cirrhosis.
• Analysis of diagnostic methods, including conventional and functional assays.
• Synthesis of therapeutic approaches for managing hemostatic complications.

Main Results:

• Cirrhosis induces complex alterations in pro- and anti-hemostatic factors.
• Functional assays like viscoelastic tests and thrombin generation assays offer better insights than conventional tests.
• An individualized, risk-based approach is recommended for managing hemostasis, especially before invasive procedures.

Conclusions:

• Understanding the complex hemostatic changes in cirrhosis is vital for patient management.
• Functional coagulation analysis is superior to conventional tests for assessing hemostatic status in cirrhosis.
• Tailored preventive measures are essential to mitigate bleeding and thrombotic risks in cirrhotic patients.