Hemostasis and thrombosis in patients with liver disease: The ups and downs
Received 11 January 2010; received in revised form 28 January 2010; accepted 29 January 2010. published online 12 May 2010.
Abstract
Patients with chronic or acute liver failure frequently show profound abnormalities in their hemostatic system. Whereas routine laboratory tests of hemostasis suggest these hemostatic alterations result in a bleeding diathesis, accumulating evidence from both clinical and laboratory studies suggest that the situation is more complex. The average patient with liver failure may be in hemostatic balance despite prolonged routine coagulation tests, since both pro- and antihemostatic factors are affected, the latter of which are not well reflected in routine coagulation testing. However, this balance may easily tip towards a hypo- or hypercoagulable situation. Indeed, patients with liver disease may encounter both hemostasis-related bleeding episodes as well as thrombotic events. During the 3rd International Symposium on Coagulopathy and Liver disease, held in Groningen, The Netherlands (18–19 September 2009), a multidisciplinary panel of experts critically reviewed the current data concerning pathophysiology and clinical consequences of hemostatic disorders in patients with liver disease. Highlights of this symposium are summarized in this review.
1Section Hepatobiliairy Surgery and Liver Transplantation, The Netherlands
2Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
3Division of GI/Hepatology, Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
4The Sheila Sherlock Hepatobiliary-Pancreatic and Liver Unit, Royal Free Hospital, London, United Kingdom
5Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padua, Italy
6Section of Hepatology, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
7Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, University Medical School and IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy
8Baylor University Medical Center, Dallas, TX, USA
9Centre de Référence des Maladies Vasculaires du Foie, AP-HP, Hôpital Beaujon, Service d’Hépatologie, Clichy, France
Corresponding author. Address: Surgical Research Laboratory, BA 44, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands. Tel.: +31 50 3619028; fax: +31 50 363 2796.
ABSTRACT