Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander, Spain; Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain; CIBER of Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander, Spain; Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain; CIBER of Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
Dig Liver Dis. 2019 Jan;51(1):95-103. doi: 10.1016/j.dld.2018.06.003. Epub 2018 Jun 12.
Knowledge of haematological abnormalities in cirrhosis has greatly improved in recent years.
To evaluate how Spanish Digestive Disease specialists manage haemostatic alterations and associated disorders in patients with cirrhosis.
All members of the Spanish Association for the Study of the Liver and Spanish Society of Digestive Pathology were invited to fill in a web-based questionnaire.
135 professionals, 93 hepatologists and 42 non-hepatologists responded to the survey. The concept of rebalanced haemostasis was known by 74.8% of them. Most specialists corrected the INR and thrombocytopenia before invasive procedures with moderate risk of bleeding or major surgery and in severe gastrointestinal bleeding. The threshold of platelets and, especially, INR used to administer blood products varied greatly. Pharmacological prophylaxis of venous thromboembolism prevailed, but it was highly dependent on the INR and platelet figures. Most participants initiated anticoagulation regardless of the degree of portal vein thrombosis, even in patients ineligible for transplantation. In potential candidates, only 56% maintained it indefinitely or until liver transplantation. No major differences between hepatologists and non-hepatologists were found.
A significant variability and certain deviation from current guidelines was observed among Spanish Digestive Disease specialists regarding management of haemostatic alterations and associated disorders in cirrhosis.
近年来，人们对肝硬化患者血液学异常的认识有了很大的提高。
评估西班牙消化疾病专家如何管理肝硬化患者的止血异常和相关疾病。
邀请所有西班牙肝病研究协会和西班牙消化病理学协会的成员填写一个基于网络的问卷。
共有 135 名专业人员，93 名肝病专家和 42 名非肝病专家对该调查做出了回应。74.8%的专家了解平衡止血的概念。大多数专家在有中度出血风险的侵入性操作或大手术前以及严重胃肠道出血时纠正国际标准化比值和血小板减少症。使用的血小板和国际标准化比值的阈值差异很大。静脉血栓栓塞的药物预防占主导地位，但它高度依赖于国际标准化比值和血小板计数。大多数参与者开始抗凝治疗，无论门静脉血栓形成的程度如何，甚至在不适合移植的患者中也是如此。在潜在的候选者中，只有 56%的人无限期或直到肝移植时才继续抗凝。在管理肝硬化患者的止血异常和相关疾病方面，肝病专家和非肝病专家之间没有发现明显的差异。
西班牙消化疾病专家在管理肝硬化患者的止血异常和相关疾病方面存在显著的差异和一定的偏差，与当前的指南不符。
