title: The Complex Role of Anticoagulation in Cirrhosis: An Updated Review of Where We Are and Where We Are Going.
abstract: Venous thromboembolism (VTE) in cirrhotic patients is an increasingly encountered problem in the daily clinical practice; there is still a debate on the ideal measures to be followed for prophylaxis and treatment of VTE among this population. Although traditionally, liver cirrhosis has been considered a disease with hypocoagulability state and increasing bleeding tendency due to severe homeostatic disruption in liver disease, until recently there is increasing awareness and evidence that cirrhotic patients are not completely protected from thrombotic events although they have an elevated international normalized ratio and auto anticoagulation. Furthermore, hypercoagulability is now an increasingly recognized aspect of chronic liver disease (CLD), and the bleeding risk of VTE prophylaxis and treatment remains unclear. In this review, we provide an updated discussion on the mechanisms involved in hemostasis in CLD as well as on the benefits and complications of anticoagulant therapy in cirrhotic patients. Overall, sufficient evidence exists, promoting the use of anticoagulation in cirrhotic patients for both VTE prophylaxis and treatment in carefully selected patients after consideration of pharmacologic or endoscopic variceal bleeding prophylaxis.
authors.affiliation: Department of Medicine, Hebrew University-Hadassah Medical Center, Ein-Kerem, Jerusalem, Israel.
authors.forename: Tawfik
authors.initials: T
authors.lastname: Khoury
authors.forename: Abu Rmeileh
authors.initials: AR
authors.lastname: Ayman
authors.forename: Jonah
authors.initials: J
authors.lastname: Cohen
authors.forename: Saleh
authors.initials: S
authors.lastname: Daher
authors.forename: Chen
authors.initials: C
authors.lastname: Shmuel
authors.forename: Meir
authors.initials: M
authors.lastname: Mizrahi
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D018579:Patient Selection; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants