Singh Achintya D, Mucha Simon R, Lindenmeyer Christina C
Department of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic.
Cleve Clin J Med. 2022 Sep 1;89(9):523-533. doi: 10.3949/ccjm.89a.21018.
Cirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic complications, challenging this dogma. We now recognize that in cirrhosis there is a simultaneous decrease in both clotting and anticlotting factors, leading to a new equilibrium. Conventional coagulation tests such as the platelet count and prothrombin time do not assess the reduced anticoagulation factors in cirrhosis and overestimate the bleeding risk, and any intervention based on these test results can lead to thrombotic complications. This article reviews the changes in hemostasis associated with cirrhosis, newer tests for assessing coagulation, and preprocedural minimization of coagulopathy.
肝硬化一直被视为一种与出血风险增加相关的低凝状态。但肝硬化患者血栓形成并发症的发生率也很高，这对这一传统观念提出了挑战。我们现在认识到，在肝硬化中，凝血因子和抗凝因子同时减少，从而导致一种新的平衡。常规凝血试验，如血小板计数和凝血酶原时间，无法评估肝硬化中抗凝因子的减少情况，并且高估了出血风险，基于这些试验结果的任何干预都可能导致血栓形成并发症。本文综述了与肝硬化相关的止血变化、评估凝血的新试验以及术前凝血障碍的最小化。
