Amarapurkar Pooja D, Amarapurkar Deepak N
Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai 400 020, India.
Int J Hepatol. 2011;2011:695470. doi: 10.4061/2011/695470. Epub 2011 Nov 17.
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.
失代偿期肝硬化患者的合成功能显著受损。许多参与凝血过程的蛋白质在肝脏中合成。失代偿期肝硬化患者常规进行的凝血检查结果异常。这导致人们普遍认为失代偿期肝硬化是获得性出血性凝血病的典型代表。如果凝血酶原时间比对照延长超过3秒，诸如肝活检、脾门静脉造影、经皮胆管造影或手术等侵入性操作会增加出血风险，并且应输注新鲜冰冻血浆来纠正凝血病。这些做法没有任何科学依据，且与新鲜冰冻血浆输血的重大风险相关。现在人们认识到，凝血是一个复杂的过程，涉及促凝和抗凝因子以及纤维蛋白溶解系统的相互作用。由于抗凝血因子和促凝血因子均减少，急慢性肝病患者的整体凝血检查结果正常，这表明肝病中的凝血病更多是一种误解而非事实。在过去几年中，手术技术有了显著改进，像肝移植这样的复杂手术可以在不使用血液或血液制品的情况下进行。肝硬化患者发生血栓形成的风险也可能增加。在本文中，我们将讨论失代偿期肝硬化中的凝血病、血栓形成风险增加及其管理。
