AGA Technical Review on Coagulation in Cirrhosis

Abstract

Conflicts of interestAll members were required to complete the disclosure statement. These statements are maintained at the American Gastroenterological Association (AGA) headquarters in Bethesda, Maryland, and pertinent disclosures are published with this report. Panel members disclosed all potential conflicts of interest according to the AGA Institute policy.

Haemostatic alterations and management of haemostasis in patients with cirrhosis

“…102 To date, no study clearly demonstrates the efficacy of anticoagulation to prevent VTE and clinicians are reliant on extrapolation from medical studies in general populations. 103 Based on data from the general medical population and recent studies specific to patients with cirrhosis, current societal guidelines support the use of thromboprophylaxis in patients with cirrhosis. 3,104 PVT occurs more frequently in patients with cirrhosis compared to the general population.…”

“…[107][108][109][110][111][112] Overall, anticoagulation appears safe and effective to prevent stroke in patients with well-compensated cirrhosis and DOACs may be safer. 103 As randomised controlled data are lacking, further evidence is needed in patients with more advanced cirrhosis to better understand the safety of anticoagulation to prevent stroke in this population.…”

“…[121][122][123][124][125][126][127][128] A recent systematic review found that 64% of patients treated with anticoagulation (LMWH or VKA) undergo recanalisation compared to 21% who do not receive anticoagulation, with similar rates of overall bleeding between groups. 103 However, these studies are limited by their retrospective (non-randomised) designs, and variations in outcome definitions and durations of treatment. Current guideline recommendations support the use of anticoagulation for treatment in patients with cirrhosis and acute or recent PVT without contraindications.…”

Mastering Core Recommendations during HEPAtology ROUNDS in Patients with Advanced Chronic Liver Disease

“…9 10 11 The Padua Prediction score has been proven to be predictive of VTE in patients with AdvCLD and can be used for VTE risk assessment. 12 13…”

“…[9][10][11] The Padua Prediction score has been proven to be predictive of VTE in patients with AdvCLD and can be used for VTE risk assessment. 12,13 It is challenging to estimate the bleeding risk in patients with cirrhosis that undergo invasive procedures. Traditional laboratory measures of coagulation have significant limitations in this population, and none account for variables such as portal-collateral pressure, flow, or endothelial dysfunction.…”