title: Is there a rationale for treatment of chronic liver disease with antithrombotic therapy?
abstract: Recent advances in the understanding of the coagulopathy in chronic liver disease have provided a strong support for anticoagulation as a new therapeutic paradigm for patients with cirrhosis. Laboratory studies indicate that the net effect of changes in hemostasis in many patients with chronic liver disease is a hypercoagulable status. In turn, clinical thrombosis is increasingly recognized as a complication of liver disease. When occurring within the liver, thrombosis may even progress the disease course. Exciting preliminary data regarding the potential of low-molecular-weight heparin to slow down the progression of liver disease indicate that this class of drugs may improve outcome without a major increase in bleeding risk. However, this new era for antithrombotic therapy in chronic liver disease is still hindered by a persistent false notion that patients with cirrhosis are "auto-anticoagulated" by their underlying liver disease. In addition, there is insufficient clinical evidence on safety and efficacy of anticoagulant therapy in cirrhosis and the studies conducted so far are limited by small sample sizes, uncontrolled treatment arms, or by their retrospective nature. Finally, a lack of knowledge on how or when to monitor antithrombotic treatment to optimize the risk-benefit ratio has restricted a widespread application of anticoagulant treatment in clinical management algorithms. Nonetheless, by systematically covering possibilities and pitfalls, this review highlights the potential of antithrombotic therapy to improve the quality of life and the clinical outcome of patients with chronic liver disease.
authors.affiliation: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Greg C G
authors.initials: GC
authors.lastname: Hugenholtz
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, United States.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.a.lisman@umcg.nl.
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use*; D002908:Chronic Disease; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D008107:Liver Diseases / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D013927:Thrombosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Chronic liver disease; Cirrhosis; Hemostasis; Thrombosis