Superimposed coagulopathic conditions in cirrhosis: infection and endogenous heparinoids, renal failure, and endothelial dysfunction.
In this article, the authors discuss three pathophysiologic mechanisms that influence the coagulation system in patients who have liver disease. First, bacterial infections may play an important role in the cause of variceal bleeding in patients who have liver cirrhosis, affecting coagulation through multiple pathways. One of the pathways through which this occurs is dependent on endogenous heparinoids, on which the authors focus in this article. Secondly, the authors discuss renal failure, a condition that is frequently encountered in patients who have liver cirrhosis. Finally, they review dysfunction of the endothelial system. The role of markers of endothelial function in cirrhotic patients, such as von Willebrand factor and endothelin-1, is discussed.
Smalberg
Jasper H
JH
Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Leebeek
Frank W G
FWG
Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands; The Netherlands Organisation for Scientific Research (NWO), Den Haag, The Netherlands. Electronic address: f.leebeek@erasmusmc.nl.
D001424:Bacterial Infections / Q000150:complications*; D015415:Biomarkers / Q000378:metabolism; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000503:physiopathology*; D019332:Endothelin-1 / Q000378:metabolism; D004730:Endothelium, Vascular / Q000503:physiopathology; D006496:Heparinoids / Q000378:metabolism*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000378:metabolism; D051437:Renal Insufficiency / Q000209:etiology*; D014648:Varicose Veins / Q000473:pathology; D014841:von Willebrand Factor / Q000378:metabolism
D015415:Biomarkers; D019332:Endothelin-1; D006496:Heparinoids; D014841:von Willebrand Factor