title: Antiplatelets and Antithrombotics in Patients with Liver Insufficiency: From Pathophysiology to Clinical Practice.
abstract: The liver represents the site of synthesis of most procoagulant and anticoagulant factors, fibrinolytic proteins and thrombopoetin while being also involved in the clearance of hemostatic and fibrinolyic proteins. Therefore in patients with liver insufficiency a great variety of disturbances can be documented resulting however in a new "rebalanced" hemostatic system with a labile equilibrium between thromboses or bleeding. Interestingly patients with liver insufficiency may present with arterial or venous thrombotic episodes requiring antiplatelet and/or antithrombotic therapy despite low platelet count or prolonged INR. The aim of this review is to point on the current knowledge regarding hemostasis in patients with liver insufficiency underlining practical recommendations of the use of antiplatelet and anticoagulant drugs in this setting.
authors.affiliation: Dipartimento Cardio-toracovascolare, SS UTIC/ SC Cardiologia 1-Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, Milan 20162, Italy.
authors.forename: Melanie
authors.initials: M
authors.lastname: Deutsch
authors.affiliation: Department of Internal Medicine, Medical School National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Koskinas
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy / Q000503:physiopathology; D048550:Hepatic Insufficiency / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013927:Thrombosis / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Liver insufficiency; antiplatelets; antithrombotics; hemostasis rebalance