Coagulation disorders in liver disease.
The liver plays a central role in the clotting process, and acute and chronic liver diseases are invariably associated with coagulation disorders due to multiple causes: decreased synthesis of clotting and inhibitor factors, decreased clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis, and accelerated intravascular coagulation. The bleeding tendency accounts for increased risk of morbidity and mortality in patients with liver disease undergoing diagnostic or therapeutic invasive procedures. Peculiar coagulation disorders are prevalent in patients with acute fatty liver of pregnancy or undergoing liver transplantation. Emerging evidence shows that sepsis further impairs hemostasis in patients with liver cirrhosis bleeding from esophageal varices. Thrombotic events, even if rare in cirrhotic patients, occur mainly in the portal and mesenteric veins. The therapeutic approach to coagulative disorders is also discussed.
Amitrano
Lucio
L
Gastroenterology Unit, A. Cardarelli Hospital, Via Morghen 92, 80129 Naples, Italy. luamitra@tin.it
Guardascione
Maria A
MA
Brancaccio
Vincenzo
V
Balzano
Antonio
A
D001424:Bacterial Infections / Q000150:complications / Q000503:physiopathology; D001777:Blood Coagulation / Q000502:physiology; D001778:Blood Coagulation Disorders / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D001779:Blood Coagulation Factors / Q000096:biosynthesis; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D017359:HELLP Syndrome / Q000503:physiopathology; D006487:Hemostasis; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D011247:Pregnancy; D013921:Thrombocytopenia / Q000503:physiopathology; D014813:Vitamin K Deficiency / Q000503:physiopathology
D001779:Blood Coagulation Factors