Divison of Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA.
Eur J Haematol. 2021 Oct;107(4):383-392. doi: 10.1111/ejh.13688. Epub 2021 Jul 29.
Hepatic cirrhosis leads to numerous hematologic derangements resulting in a complex and tenuously rebalanced hemostatic milieu. The utility of common hematologic tests including the INR and aPTT in assessing hemostatic and thrombotic risk in patients with cirrhosis is limited, and consensus on transfusion thresholds and proper management of thrombotic complications continues to evolve. This review summarizes the pathophysiology of key derangements of hemostasis including those of platelets, von Willebrand factor, pro- and anticoagulation factors, and fibrin. Additionally, the pathogenesis, consequences, optimal management, and prevention of major thrombotic and bleeding complications in cirrhosis arte discussed.
肝硬化导致多种血液学紊乱，导致止血环境复杂且脆弱平衡。包括 INR 和 aPTT 在内的常用血液学检测在评估肝硬化患者的止血和血栓形成风险方面的作用有限，关于输血阈值和血栓并发症的适当处理的共识仍在不断发展。这篇综述总结了止血关键紊乱的病理生理学，包括血小板、血管性血友病因子、促凝和抗凝因子以及纤维蛋白。此外，还讨论了肝硬化的主要血栓形成和出血并发症的发病机制、后果、最佳治疗和预防。
