Khoury Tawfik, Ayman Abu Rmeileh, Cohen Jonah, Daher Saleh, Shmuel Chen, Mizrahi Meir
Department of Medicine, Hebrew University-Hadassah Medical Center, Ein-Kerem, Jerusalem, Israel.
Digestion. 2016;93(2):149-59. doi: 10.1159/000442877. Epub 2016 Jan 9.
Venous thromboembolism (VTE) in cirrhotic patients is an increasingly encountered problem in the daily clinical practice; there is still a debate on the ideal measures to be followed for prophylaxis and treatment of VTE among this population. Although traditionally, liver cirrhosis has been considered a disease with hypocoagulability state and increasing bleeding tendency due to severe homeostatic disruption in liver disease, until recently there is increasing awareness and evidence that cirrhotic patients are not completely protected from thrombotic events although they have an elevated international normalized ratio and auto anticoagulation. Furthermore, hypercoagulability is now an increasingly recognized aspect of chronic liver disease (CLD), and the bleeding risk of VTE prophylaxis and treatment remains unclear. In this review, we provide an updated discussion on the mechanisms involved in hemostasis in CLD as well as on the benefits and complications of anticoagulant therapy in cirrhotic patients. Overall, sufficient evidence exists, promoting the use of anticoagulation in cirrhotic patients for both VTE prophylaxis and treatment in carefully selected patients after consideration of pharmacologic or endoscopic variceal bleeding prophylaxis.
在日常临床实践中，肝硬化患者的静脉血栓栓塞（VTE）是一个日益常见的问题；对于该人群VTE的预防和治疗应采取的理想措施仍存在争议。传统上，肝硬化被认为是一种由于肝病中严重的内环境紊乱而导致低凝状态和出血倾向增加的疾病，但直到最近，人们越来越意识到并有证据表明，尽管肝硬化患者的国际标准化比值升高且存在自身抗凝现象，但他们并未完全免受血栓形成事件的影响。此外，高凝状态现在已日益被认为是慢性肝病（CLD）的一个特征，而VTE预防和治疗的出血风险仍不明确。在本综述中，我们提供了关于CLD止血机制以及肝硬化患者抗凝治疗的益处和并发症的最新讨论。总体而言，有充分的证据支持在经过仔细挑选的肝硬化患者中，在考虑药物或内镜下预防静脉曲张出血的情况下，使用抗凝药物进行VTE的预防和治疗。
