Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Semin Thromb Hemost. 2020 Sep;46(6):716-723. doi: 10.1055/s-0040-1715449. Epub 2020 Aug 20.
Bleeding and thrombosis are both common complications that patients with advanced liver disease experience. While hemostatic pathways remain largely intact with cirrhosis, this balance can quickly shift in the direction of bleeding or clotting in an unpredictable manner. A growing body of literature is attempting to shed light on difficult scenarios that clinicians often face, ranging from predicting and mitigating bleeding risk in those who need invasive procedures to determining the best strategies to manage both bleeding and thrombotic complications when they occur. Studies examining hemostasis in those with advanced liver disease, however, often include heterogeneous cohorts with varied methodology. While these studies often select a cohort of all types and degrees of cirrhosis, emerging evidence suggests significant differences in underlying systemic inflammation and hemostatic abnormalities among specific phenotypes of liver disease, ranging from compensated cirrhosis to decompensated cirrhosis and acute-on-chronic liver failure. It is paramount that future studies account for these differing disease severities if we hope to address the many critical knowledge gaps in this field.
出血和血栓形成是晚期肝病患者常见的并发症。虽然肝硬化时止血途径基本保持完整，但这种平衡可能会迅速向出血或血栓形成的方向转变，且变化方式难以预测。越来越多的文献试图阐明临床医生经常面临的困难情况，包括预测和减轻需要侵入性操作的患者的出血风险，以及确定发生出血和血栓并发症时的最佳处理策略。然而，检查晚期肝病患者止血情况的研究通常包括具有不同方法的异质队列。虽然这些研究通常选择所有类型和程度的肝硬化患者队列，但新出现的证据表明，在特定的肝病表型（从代偿性肝硬化到失代偿性肝硬化和慢加急性肝衰竭）中，潜在的系统性炎症和止血异常存在显著差异。如果我们希望解决该领域的许多关键知识空白，那么未来的研究就必须考虑到这些不同的疾病严重程度。
