Aggarwal Ashish, Puri Kanika, Liangpunsakul Suthat
Ashish Aggarwal, Kanika Puri, Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, IN 46202, United States.
World J Gastroenterol. 2014 May 21;20(19):5737-45. doi: 10.3748/wjg.v20.i19.5737.
Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots. Lately, studies have shown that these patients may probably be at an increased risk of venous thrombotic complications. Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research, it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors. Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis [deep vein thrombosis (DVT) and pulmonary embolism (PE)]; it has also been associated with progression of liver fibrosis. The use of anticoagulants in cirrhosis patients is a challenging, and often a scary situation. This review summarizes the current literature on the prevalence of venous thrombosis (DVT and PE), risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease.
传统上认为肝硬化患者可预防血栓形成。最近，研究表明这些患者可能有静脉血栓并发症风险增加的情况。尽管慢性肝病患者的止血变化以及可能预测出血与血栓并发症的因素仍是一个活跃的研究领域，但据信由于促凝血和抗凝因子的肝脏合成同时减少，这些患者的凝血级联处于微妙的平衡状态。肝硬化患者的血栓形成状态不仅导致门静脉或非门静脉血栓形成[深静脉血栓形成（DVT）和肺栓塞（PE）]；它还与肝纤维化进展有关。在肝硬化患者中使用抗凝剂是一项具有挑战性的事情，而且往往令人担忧。这篇综述总结了关于慢性肝病患者静脉血栓形成（DVT和PE）的患病率、危险因素以及预防性和治疗性抗凝的安全性的当前文献。
