title: [Liver disease and hemostasis--evaluation of bleeding risk].
abstract: In severe liver disease, simultaneous abnormalities in procoagulant and anticoagulant pathways seem to maintain the hemostatic balance, provided that the platelet level is sufficient. Common coagulation screening tests such as INR fail to measure the concomitant anticoagulant deficiencies and fibrinolytic abnormalities, and do not predict bleeding in patients with compensated liver disease undergoing invasive procedures. Thus, specific INR cut-off levels and prophylactic use of fresh-frozen plasma are discouraged. Volume expansion, hemodynamic disruption, endothelial dysfunction, and infections increase the bleeding risk. Individualized bleeding risk assessment mandates evaluation of the patient's clinical condition and a comprehensive assessment of the hemostatic system.
authors.affiliation: HUS, medisiininen tulosyksikkö, Marian sairaala.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Aberg
authors.forename: Riitta
authors.initials: R
authors.lastname: Lassila
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Koivusalo
authors.forename: Kirsti
authors.initials: K
authors.lastname: Numminen
authors.forename: Hannu
authors.initials: H
authors.lastname: Nuutinen
authors.forename: Heikki
authors.initials: H
authors.lastname: Mäkisalo
mesh_terms: D001780:Blood Coagulation Tests; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control*; D006487:Hemostasis; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors