The coagulation cascade in cirrhosis.
The coagulation "cascade" model accurately represents the mechanisms of the prothrombin time and activated partial thromboplastin time tests. However, these tests and the "cascade" model do not accurately reflect the risk of hemorrhage or thrombosis in vivo. In hepatic insufficiency, a balanced reduction in the levels of most of pro- and anticoagulant proteins produced in the liver does not impair thrombin generation until levels are quite low. However, the ability of the coagulation system to tolerate or recover from an insult is markedly impaired in liver disease. This allows the coagulation system to be more easily tipped into a state favoring either hemorrhage or thrombosis.
Monroe
Dougald M
DM
Carolina Cardiovascular Biology Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Hoffman
Maureane
M
Carolina Cardiovascular Biology Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA; Pathology and Laboratory Medicine Service, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Department of Pathology, Duke University Medical Center, Durham, NC, USA. Electronic address: maureane@med.unc.edu.
D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology / Q000378:metabolism*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D001792:Blood Platelets / Q000378:metabolism; D006470:Hemorrhage / Q000097:blood / Q000209:etiology; D006487:Hemostasis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000378:metabolism; D017093:Liver Failure / Q000097:blood* / Q000150:complications / Q000378:metabolism; D008954:Models, Biological; D011517:Prothrombin Time; D013917:Thrombin / Q000378:metabolism; D013925:Thromboplastin / Q000378:metabolism; D013927:Thrombosis / Q000209:etiology
D001779:Blood Coagulation Factors; D013925:Thromboplastin; D013917:Thrombin