Licinio Raffaele, Principi Mariabeatrice, Losurdo Giuseppe, Castellaneta Nicola Maurizio, Ierardi Enzo, Di Leo Alfredo
Gastroenterology Section, Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Azienda Universitario-Ospedaliera Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy.
ScientificWorldJournal. 2014;2014:895839. doi: 10.1155/2014/895839. Epub 2014 Dec 29.
Cirrhosis has always been regarded as hemorrhagic coagulopathy caused by the reduction in the hepatic synthesis of procoagulant proteins. However, with the progression of liver disease, the cirrhotic patient undergoes a high rate of thrombotic phenomena in the portal venous system. Although the progression of liver failure produces a reduction in the synthesis of anticoagulant molecules, a test able to detect the patients with hemostatic balance shifting towards hypercoagulability has not yet been elaborated. The need of treatment and/or prophylaxis of cirrhotic patients is demonstrated by the increased mortality, the risk of bleeding from esophageal varices, and the mortality of liver transplantation, when portal vein thrombosis (PVT) occurs even if current guidelines do not give indications about PVT treatment in cirrhosis. In view of the general feeling that the majority of cirrhotic patients at an advanced stage may be in a procoagulant condition (suggested by the sharp increase in the prevalence of PVT), it is presumable that a prophylaxis of this population could be of benefit. The safety and the efficacy of prophylaxis and treatment with enoxaparin in patients with cirrhosis demonstrated by a single paper suggest this option only in controlled trials and, currently, there are no sufficient evidences for a recommendation in the clinical practice.
肝硬化一直被视为由促凝血蛋白肝脏合成减少所致的出血性凝血病。然而，随着肝病进展，肝硬化患者门静脉系统血栓形成现象发生率很高。尽管肝衰竭进展会导致抗凝分子合成减少，但尚未研发出一种能检测止血平衡向高凝状态转变患者的检测方法。肝硬化患者因死亡率增加、食管静脉曲张出血风险以及门静脉血栓形成（PVT）时肝移植死亡率增加而需要进行治疗和/或预防，即便当前指南未针对肝硬化患者的PVT治疗给出指导意见。鉴于普遍认为大多数晚期肝硬化患者可能处于促凝血状态（PVT患病率急剧上升表明了这一点），推测对这一人群进行预防可能有益。一篇论文证明了依诺肝素对肝硬化患者进行预防和治疗的安全性及有效性，但仅表明在对照试验中可采用此方法，目前尚无足够证据支持在临床实践中进行推荐。
