Lisman Ton, Hernandez-Gea Virginia, Magnusson Maria, Roberts Lara, Stanworth Simon, Thachil Jecko, Tripodi Armando
Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain.
J Thromb Haemost. 2021 Apr;19(4):1116-1122. doi: 10.1111/jth.15239.
Patients with liver diseases acquire complex alterations in their hemostatic system that may lead to abnormalities in routine diagnostic test of hemostasis. Thrombocytopenia, prolongations in the prothrombin time and activated partial thromboplastin time, and decreased plasma fibrinogen are common in patients with advanced liver disease. Historically, liver diseases therefore have been classified as an acquired bleeding disorder. Laboratory and clinical observations have demonstrated that although routine diagnostic tests of hemostasis suggest a hypocoagulable state, patients with liver disease also tend to develop thrombotic events. Overall, patients have commensurate changes in both pro- and antihemostatic pathways. This new hemostatic balance, however, appears much more fragile than the hemostatic balance in individuals with normal liver function, and patients with liver disease can readily experience both hemostasis-related bleeding and thrombotic events. These insights into the hemostatic balance in patients with liver disease have led to revised recommendations for clinical management of hemostasis. In 2020, an SSC working group within the ISTH has been founded with the aim to disseminate new concepts on prevention and treatment of bleeding and thrombosis in patients with liver disease. The current document will outline the hemostatic changes in patients with liver disease, the limitations of routine diagnostic tests of hemostasis, and the concept of rebalanced hemostasis.
肝病患者的止血系统会发生复杂改变，这可能导致止血常规诊断测试出现异常。血小板减少、凝血酶原时间和活化部分凝血活酶时间延长以及血浆纤维蛋白原降低在晚期肝病患者中很常见。因此，从历史上看，肝病被归类为一种获得性出血性疾病。实验室和临床观察表明，尽管止血常规诊断测试提示存在低凝状态，但肝病患者也容易发生血栓形成事件。总体而言，患者的促凝血和抗凝血途径都有相应变化。然而，这种新的止血平衡似乎比肝功能正常者的止血平衡更为脆弱，肝病患者很容易出现与止血相关的出血和血栓形成事件。对肝病患者止血平衡的这些认识促使人们对止血的临床管理提出了修订建议。2020年，国际血栓与止血学会（ISTH）成立了一个SSC工作组，旨在传播肝病患者出血和血栓形成预防与治疗的新概念。本文件将概述肝病患者的止血变化、止血常规诊断测试的局限性以及重新平衡止血的概念。
