Bleeding and Thrombotic Complications in Patients With Cirrhosis: A State-of-the-Art Appraisal

Rautou, Pierre‐Emmanuel; Caldwell, Stephen H.; Villa, Erica

doi:10.1016/j.cgh.2023.04.016

Cited by 19 publications

(13 citation statements)

References 82 publications

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“…However, it is now widely accepted that the hemostatic system of those patients remains well balanced, as a result of simultaneous changes in pro- and anti-hemostatic systems, and that current coagulation tests are unable to accurately predict bleeding risk. 30 Several models and nomograms have been developed to identify patients at higher risk of bleeding and/or need for transfusion during OLT, but they are either cumbersome and difficult to translate into clinical practice, or suboptimal. 2 , 16 , [31] , [32] , [33] …”

Section: Discussionmentioning

confidence: 99%

Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

Giabicani,

Joly,

Sigaut

et al. 2024

JHEP Reports

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Section: Discussionmentioning

confidence: 99%

Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

Giabicani,

Joly,

Sigaut

et al. 2024

JHEP Reports

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“…While this position paper will be a valuable tool to help homogenise further studies on invasive procedures in patients with cirrhosis, it should be noted that the rate of bleeding and the risk of bleeding are not interchangeable concepts. 11 …”

Section: Discussionmentioning

confidence: 99%

Expert opinion on bleeding risk from invasive procedures in cirrhosis

Riescher-Tuczkiewicz,

Caldwell,

Kamath

et al. 2024

JHEP Reports

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“…Consistently, anticoagulation has been associated with lower rates of recurrent thrombosis, major bleeding, and mortality. [6] It is important to note that patients with liver cirrhosis who present with a low platelet count and prolonged prothrombin time should not be considered "automatically anticoagulated" and therefore protected from thrombotic events. Their coagulation status is more complex, involving alterations in both procoagulant and anticoagulant factors.…”

Section: Discussionmentioning

confidence: 99%

“…Consistently, anticoagulation has been associated with lower rates of recurrent thrombosis, major bleeding, and mortality. [6]…”

Section: Discussionmentioning

confidence: 99%

Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis in a patient with liver cirrhosis: A case report

Mitev,

Topalova-Dimitrova,

Varlyakov

et al. 2023

Medicine

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Rationale: Acute mesenteric ischemia due to superior mesenteric vein (SMV) thrombosis is a rare yet potentially life-threatening emergency. Our case report explores this condition in the context of a patient with liver cirrhosis due to Wilson disease. We specifically highlight the complex derangement of the coagulative balance in liver cirrhosis. Patient concerns: A 34-year-old female with Wilson disease-related cirrhosis presented with intractable abdominal pain, nausea, and vomiting that showed no response to antispasmodic medication. Diagnoses: A contrast-enhanced abdominal computed tomography scan and Doppler ultrasound confirmed an intraluminal filling defect in the SMV, leading to the diagnosis of SMV thrombosis. Interventions: Prompt anticoagulation, intravenous fluids, and an antibiotic were initiated. Surgical consultation recommended conservative therapy with close monitoring. Outcomes: Over the following 2 days, the patient’s condition improved considerably, with almost complete resolution of her symptoms. Genetic testing identified a 4G/4G homozygous genotype of the plasminogen activator inhibitor 1 gene, associated with a higher risk of thrombosis in the vessels of internal organs. After 2 months of sustained anticoagulant therapy, a follow-up contrast-enhanced computed tomography scan revealed near-complete recanalization of the SMV, and the patient remained symptom-free. Lessons: This case underscores the importance of early detection and treatment of acute mesenteric ischemia in patients with liver cirrhosis, as well as the potential role of genetic factors in thrombosis.

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Bleeding and Thrombotic Complications in Patients With Cirrhosis: A State-of-the-Art Appraisal

Cited by 19 publications

References 82 publications

Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

Expert opinion on bleeding risk from invasive procedures in cirrhosis

Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis in a patient with liver cirrhosis: A case report

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