title: Management of coagulation abnormalities in liver disease.
abstract: Liver disease is characterized by changes in all phases of hemostasis. These hemostatic alterations were long considered to predispose patients with liver disease towards a bleeding tendency, as they are associated with prolonged conventional coagulation tests. However, these patients may also suffer from thrombotic complications, and we now know that the hemostatic system in patient with liver disease is, in fact, in a rebalanced state. In this review we discuss the concept of rebalanced hemostasis and its implications for clinical management of patients with liver disease. For instance, there is no evidence that the use of prophylactic blood product transfusion prior to invasive procedures reduces bleeding risk. Clinicians should also be aware of the possibility of thrombosis occurring in patients with a liver disease, and regular thrombosis prophylaxis should not be withheld in these patients.
authors: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, BA44, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
authors: Wilma
authors: W
authors: Potze
authors: Robert J
authors: RJ
authors: Porte
authors: Ton
authors: T
authors: Lisman
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D003029:Coagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005342:Fibrinolysis / Q000187:drug effects; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D003029:Coagulants; D005343:Fibrinolytic Agents
keywords: anticoagulants; bleeding; bleeding management; coagulation; coagulation tests; hemostasis; liver disease; thrombin generation; thrombosis; thrombosis management