Lisman Ton, Leebeek Frank W G
Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Dig Surg. 2007;24(4):250-8. doi: 10.1159/000103655. Epub 2007 Jul 27.
In most patients with acute or chronic liver failure, extensive changes in all pathways contributing to hemostasis are found. These hemostatic alterations concern both pro- and anti-hemostatic pathways, and therefore the net result of the hemostatic unbalance is unclear. Although it is generally believed that patients with liver disease have a hemostasis-related bleeding tendency, this concept is challenged in recent literature. Although the bleeding problems in patients with liver disease are obvious, the clinically most relevant bleeding episodes, i.e., bleeding from ruptured varices or ulcers, are due to vascular abnormalities and portal hypertension, and not to an abnormal hemostatic system. Moreover, patients with liver disease sometimes experience thrombosis of the portal vein or hepatic artery, which is in part attributed to hypercoagulation. In addition, a substantial part of the patients with liver disease undergoing liver transplantation can nowadays undergo this major surgical procedure, which involves significant hemostatic challenges, without transfusion of blood products. Therefore, the recent debate on the presence of a major hemostatic defect in patients with liver disease seems justified. This paper will review the hemostatic changes that occur in acute and chronic liver failure, and will review hemostasis testing and reversal of coagulopathy in these patients.
在大多数急性或慢性肝衰竭患者中，可发现所有参与止血的途径均有广泛改变。这些止血改变涉及促凝血和抗凝血途径，因此止血失衡的最终结果尚不清楚。尽管人们普遍认为肝病患者有与止血相关的出血倾向，但这一概念在近期文献中受到了挑战。虽然肝病患者的出血问题很明显，但临床上最相关的出血事件，即静脉曲张破裂或溃疡出血，是由于血管异常和门静脉高压，而非止血系统异常。此外，肝病患者有时会发生门静脉或肝动脉血栓形成，部分原因是高凝状态。此外，如今相当一部分接受肝移植的肝病患者在不输血制品的情况下就能接受这一重大外科手术，而该手术涉及重大的止血挑战。因此，近期关于肝病患者是否存在主要止血缺陷的争论似乎是有道理的。本文将综述急性和慢性肝衰竭时发生的止血变化，并将综述这些患者的止血检测及凝血病的纠正。
