Potze Wilma, Porte Robert J, Lisman Ton
Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, BA44, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Expert Rev Gastroenterol Hepatol. 2015 Jan;9(1):103-14. doi: 10.1586/17474124.2014.934673. Epub 2014 Jun 26.
Liver disease is characterized by changes in all phases of hemostasis. These hemostatic alterations were long considered to predispose patients with liver disease towards a bleeding tendency, as they are associated with prolonged conventional coagulation tests. However, these patients may also suffer from thrombotic complications, and we now know that the hemostatic system in patient with liver disease is, in fact, in a rebalanced state. In this review we discuss the concept of rebalanced hemostasis and its implications for clinical management of patients with liver disease. For instance, there is no evidence that the use of prophylactic blood product transfusion prior to invasive procedures reduces bleeding risk. Clinicians should also be aware of the possibility of thrombosis occurring in patients with a liver disease, and regular thrombosis prophylaxis should not be withheld in these patients.
肝脏疾病的特征是止血各阶段均发生变化。长期以来，这些止血改变被认为会使肝病患者易于出现出血倾向，因为它们与传统凝血试验延长有关。然而，这些患者也可能发生血栓形成并发症，并且我们现在知道，肝病患者的止血系统实际上处于一种重新平衡的状态。在本综述中，我们讨论了重新平衡止血的概念及其对肝病患者临床管理的影响。例如，没有证据表明在侵入性操作前使用预防性血液制品输血可降低出血风险。临床医生还应意识到肝病患者发生血栓形成的可能性，并且不应不给这些患者进行常规的血栓形成预防。
