Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Surgical Research Laboratory, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Semin Thromb Hemost. 2021 Jul;47(5):601-609. doi: 10.1055/s-0040-1718924. Epub 2021 Mar 26.
Patients with liver disease acquire complex changes in their hemostatic system. Historically, these patients were considered to have a bleeding tendency related, in part, to a hyperfibrinolytic state. However, studies using more modern fibrinolysis tests have questioned the presence of a hyperfibrinolytic state in patients with liver disease and its association with bleeding risk. It may be that the sickest patients with liver disease do have fibrinolytic abnormalities. However, the debate on the fibrinolytic state of patients with (decompensated) cirrhosis or critically ill liver disease is complicated by the fact that hypo- and hyperfibrinolysis have been poorly defined. This could, in part, be explained by the lack of reliable tests that assess a patient's fibrinolytic status. Moreover, large clinical studies on the relationship between bleeding and fibrinolysis in patients with liver disease are scarce. Here, we provide an overview of the current knowledge on fibrinolysis in various types of liver diseases and possible implications as a target for therapeutic strategies in liver disease. As antifibrinolytic therapy has been shown to be safe and effective during liver transplantation, it could potentially be of use in patients with (either laboratory-established or suspected) hyperfibrinolysis-related bleeding.
肝病患者的止血系统会发生复杂变化。从历史上看，这些患者被认为有出血倾向，部分原因是纤溶亢进状态。然而，使用更现代的纤溶试验的研究对肝病患者是否存在纤溶亢进状态及其与出血风险的关系提出了质疑。可能是病情最严重的肝病患者确实存在纤维蛋白溶解异常。然而，（代偿失调）肝硬化或重症肝病患者的纤溶状态的争论因低纤溶和高纤溶定义不良而变得复杂。部分原因可能是缺乏评估患者纤溶状态的可靠试验。此外，关于肝病患者出血与纤溶之间关系的大型临床研究很少。在这里，我们概述了各种类型肝病中纤溶的最新知识，以及作为肝病治疗策略靶点的可能意义。由于纤溶抑制剂治疗在肝移植期间已被证明是安全有效的，因此它可能对（实验室确定或疑似）与纤溶亢进相关的出血的患者有用。
