University of Virginia Coagulation in Liver Disease Study Group, University of Virginia Medical Center Charlottesville, VA 22908, USA.
Ann Hepatol. 2012 Sep-Oct;11(5):686-90.
The relative incidence of bleeding and thrombotic events and the use of blood products in hospitalized cirrhosis patients have not been widely reported. We aimed to estimate the magnitude of bleeding events and venous thrombosis in consecutive hospitalized cirrhotic patients over a finite time period and to examine the amount and indications for blood product use in cirrhosis patients admitted to a tertiary care center.
Among patients admitted with decompensated liver disease, 34 (40%) suffered bleeding events (about one-half non-variceal) and 6 patients (7%) suffered deep venous thrombosis. In the blood product survey, 168 patients were transfused with plasma or platelets during the survey inter- vals. Liver disease patients accounted for 7.7% of the total but disproportionately consumed 32.4% (46 of 142) of the units of plasma mostly administered as prophylaxis. In contrast, cirrhosis patients received only 7 of the 53 units of platelets transfused (13.2%) during the survey intervals.
Coagulation issues constitute a common problem in patients with liver disease. Recent advances in laboratory testing have shown that stable cirrhosis patients are relatively hypercoagulable. The result of this prospective survey among decompensated (unstable) cirrhosis patients shows that, while DVT is not uncommon, bleeding (non-variceal in one half) remains the dominant clinical problem. This situation likely sustains the common practice of plasma infusion in these patients although its use is of unproven and questionable benefit. Better clinical tools are needed to refine clinical practice in this setting.
住院肝硬化患者出血和血栓事件的相对发生率以及血液制品的使用尚未广泛报道。我们旨在评估在有限时间内连续住院肝硬化患者出血事件和静脉血栓形成的程度，并检查在三级护理中心入院的肝硬化患者血液制品的使用量和适应证。
在因失代偿性肝病入院的患者中，有 34 例（40%）发生出血事件（约一半为非静脉曲张性），6 例（7%）发生深静脉血栓形成。在血液制品调查中，在调查期间，168 名患者输注了血浆或血小板。肝病患者占总数的 7.7%，但不成比例地消耗了 32.4%（46/142）的血浆单位，其中大部分是作为预防措施给予的。相比之下，在调查期间，肝硬化患者仅接受了 53 单位血小板输注中的 7 个单位（13.2%）。
凝血问题是肝病患者常见的问题。实验室检测的最新进展表明，稳定的肝硬化患者相对高凝。这项在失代偿（不稳定）肝硬化患者中进行的前瞻性调查结果表明，虽然 DVT 并不罕见，但出血（一半为非静脉曲张性）仍然是主要的临床问题。这种情况可能维持了在这些患者中输注血浆的常见做法，尽管其使用效果尚未得到证实，且存在疑问。在此背景下，需要更好的临床工具来完善临床实践。
