Hemostasis and thrombosis in patients with liver disease: The ups and downs

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.

Keywords: Liver disease, Hemostasis, Thrombosis, Bleeding, Thrombin, Platelet, Non-alcoholic steatohepatitis

Abbreviations: PT, prothrombin time, APTT, activated partial thromboplastin time, VWF, von Willebrand factor, NAFLD, non-alcoholic fatty liver disease, PAI-1, plasminogen activator inhibitor-1, NASH, non-alcoholic steatohepatitis, INR, international normalized ratio, EVL, endoscopic variceal ligation, ALF, acute liver failure, rFVIIa, recombinant factor VIIa, ICP, intracranial pressure, PVT, portal vein thrombosis, HAT, hepatic artery thrombosis, AASLD, American society for the study of liver diseases