MGH Alcohol Liver Center, Boston, MA, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Blake 4, 55 Fruit Street, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Blake 4, 55 Fruit Street, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
Clin Liver Dis. 2022 Feb;26(1):1-12. doi: 10.1016/j.cld.2021.08.002. Epub 2021 Sep 17.
Management of coagulopathy in patients with advanced liver disease undergoing therapeutic endoscopic procedures is complex. Improvements in the understanding of hemostasis at a physiologic level have highlighted the inaccuracy of currently available clinical tests, like platelet count and prothrombin time, in estimating hemostasis in patients with cirrhosis. With identification of novel factors that contribute to bleeding risk in patients with cirrhosis, there is a dearth of clinical trial data that account for all potentially relevant factors and that examine interventions to reduce bleeding risk. Precise recommendations regarding transfusion strategies based on hemostatic test results in patients with cirrhosis are impractical.
管理接受治疗性内镜操作的晚期肝病患者的出凝血障碍较为复杂。人们对生理水平止血的理解有所提高，这凸显了目前可用的临床检测（如血小板计数和凝血酶原时间）在评估肝硬化患者止血功能方面的不准确性。随着对导致肝硬化患者出血风险的新因素的识别，缺乏考虑所有潜在相关因素并检查减少出血风险干预措施的临床试验数据。基于肝硬化患者止血检测结果的输血策略的精确建议是不切实际的。
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