Heparin-like effect in liver disease and liver transplantation.
Liver cirrhosis is characterized by impairment of primary and secondary hemostasis but it is not clear how this impairment is related to the bleeding problems seen in cirrhosis. This delicate hemostatic balance can be perturbed by numerous conditions, such as variceal bleeding, renal failure, or infection/sepsis, which may lead to worsening of coagulation status to date. The role of endogenous heparinoids (glycosaminoglycans) in the coagulopathy of patients who have cirrhosis has been demonstrated by thromboelastography with the addition of heparinase I in patients who have recent variceal bleeding and infection. The heparin-like effect has also been demonstrated to be part of the coagulopathy seen after reperfusion in patients who have cirrhosis and are undergoing liver transplant. Therapeutic implications of these findings are not clear at the moment and the use of drugs able to cleave heparinoids should be explored.
Senzolo
M
M
Division of Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padua, Via Giustiniani 2, 35136, Padova, Italy.
Cholongitas
E
E
The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Thalheimer
U
U
The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Riddell
Anne
A
Department of Heamophilia and Haemostasis, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Agarwal
S
S
Department of Anesthesia, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Mallett
S
S
Department of Anesthesia, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Ferronato
C
C
Division of Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padua, Via Giustiniani 2, 35136, Padova, Italy.
Burroughs
A K
AK
The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Electronic address: andrew.burroughs@royalfree.nhs.uk.
D001777:Blood Coagulation; D003141:Communicable Diseases / Q000150:complications; D006470:Hemorrhage / Q000209:etiology / Q000378:metabolism* / Q000628:therapy; D006487:Hemostasis; D006494:Heparin Antagonists / Q000627:therapeutic use; D019763:Heparin Lyase; D006496:Heparinoids / Q000378:metabolism*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications* / Q000378:metabolism; D016031:Liver Transplantation; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000378:metabolism* / Q000628:therapy; D011479:Protamines / Q000627:therapeutic use; D013916:Thrombelastography; D014648:Varicose Veins / Q000150:complications
D006494:Heparin Antagonists; D006496:Heparinoids; D011479:Protamines; D019763:Heparin Lyase