Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis
Patients with decompensated liver cirrhosis have significantly impaired synthetic function. Many proteins involved in the coagulation process are synthesized in the liver. Routinely performed tests of the coagulation are abnormal in patients with decompensated liver cirrhosis. This has led to the wi...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | International Journal of Hepatology |
| Online Access: | http://dx.doi.org/10.4061/2011/695470 |
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| author | Pooja D. Amarapurkar Deepak N. Amarapurkar |
| author_facet | Pooja D. Amarapurkar Deepak N. Amarapurkar |
| author_sort | Pooja D. Amarapurkar |
| collection | DOAJ |
| description | Patients with decompensated liver cirrhosis have significantly impaired synthetic function. Many proteins involved in the coagulation process are synthesized in the liver. Routinely performed tests of the coagulation are abnormal in patients with decompensated liver cirrhosis. This has led to the widespread belief that decompensated liver cirrhosis is prototype of acquired hemorrhagic coagulopathy. If prothrombin time is prolonged more than 3 seconds over control, invasive procedures like liver biopsy, splenoportogram, percutaneous cholangiography, or surgery were associated with increased risk of bleeding, and coagulopathy should be corrected with infusion of fresh frozen plasma. These practices were without any scientific evidence and were associated with significant hazards of fresh frozen plasma transfusion. Now, it is realized that coagulation is a complex process involving the interaction of procoagulation and anticoagulation factors and the fibrinolytic system. As there is reduction in both anti and procoagulant factors, global tests of coagulation are normal in patients with acute and chronic liver disease indicating that coagulopathy in liver disease is more of a myth than a reality. In the last few years, surgical techniques have substantially improved, and complex procedures like liver transplantation can be done without the use of blood or blood products. Patients with liver cirrhosis may also be at increased risk of thrombosis. In this paper, we will discuss coagulopathy, increased risk of thrombosis, and their management in decompensated liver cirrhosis. |
| format | Article |
| id | doaj-art-f49ad2b09e124a778fcd99c9101e24cb |
| institution | Kabale University |
| issn | 2090-3448 2090-3456 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Hepatology |
| spelling | doaj-art-f49ad2b09e124a778fcd99c9101e24cb2025-02-03T01:26:12ZengWileyInternational Journal of Hepatology2090-34482090-34562011-01-01201110.4061/2011/695470695470Management of Coagulopathy in Patients with Decompensated Liver CirrhosisPooja D. Amarapurkar0Deepak N. Amarapurkar1Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai 400 020, IndiaAmeya Co-Op Housing Society, New Prabhadevi Road, Prabhadevi, Mumbai 400 025, IndiaPatients with decompensated liver cirrhosis have significantly impaired synthetic function. Many proteins involved in the coagulation process are synthesized in the liver. Routinely performed tests of the coagulation are abnormal in patients with decompensated liver cirrhosis. This has led to the widespread belief that decompensated liver cirrhosis is prototype of acquired hemorrhagic coagulopathy. If prothrombin time is prolonged more than 3 seconds over control, invasive procedures like liver biopsy, splenoportogram, percutaneous cholangiography, or surgery were associated with increased risk of bleeding, and coagulopathy should be corrected with infusion of fresh frozen plasma. These practices were without any scientific evidence and were associated with significant hazards of fresh frozen plasma transfusion. Now, it is realized that coagulation is a complex process involving the interaction of procoagulation and anticoagulation factors and the fibrinolytic system. As there is reduction in both anti and procoagulant factors, global tests of coagulation are normal in patients with acute and chronic liver disease indicating that coagulopathy in liver disease is more of a myth than a reality. In the last few years, surgical techniques have substantially improved, and complex procedures like liver transplantation can be done without the use of blood or blood products. Patients with liver cirrhosis may also be at increased risk of thrombosis. In this paper, we will discuss coagulopathy, increased risk of thrombosis, and their management in decompensated liver cirrhosis.http://dx.doi.org/10.4061/2011/695470 |
| spellingShingle | Pooja D. Amarapurkar Deepak N. Amarapurkar Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis International Journal of Hepatology |
| title | Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis |
| title_full | Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis |
| title_fullStr | Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis |
| title_full_unstemmed | Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis |
| title_short | Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis |
| title_sort | management of coagulopathy in patients with decompensated liver cirrhosis |
| url | http://dx.doi.org/10.4061/2011/695470 |
| work_keys_str_mv | AT poojadamarapurkar managementofcoagulopathyinpatientswithdecompensatedlivercirrhosis AT deepaknamarapurkar managementofcoagulopathyinpatientswithdecompensatedlivercirrhosis |