Hemostatic Abnormalities and Liver Diseases

Abstract

Professor Eberhard F. Mammen greatly contributed to the understanding of the relationship between hemostatic abnormalities and liver diseases. The physiology of the hemostatic system is closely linked to liver function because the liver parenchymal cells produce most of the factors of the clotting and fibrinolytic systems. Acute or chronic hepatocellular diseases and hepatic failure including liver cirrhosis, vitamin K deficiency, liver surgery including liver transplantation, and sclerotherapy of bleeding esophageal varices, which were classified by Prof. Mammen, show various hemostatic abnormalities in the coagulation system, fibrinolytic system, platelets, and the reticuloendothelial system. Hemostatic abnormalities in patients with hepatic failure or in those that have undergone liver surgery are similar to those in disseminated intravascular coagulation. Prof. Mammen also contributed to the study of vitamin K-dependent clotting factors, antithrombin, and hemostatic molecular markers. Partly based on this work, the prothrombin time-international normalized ratio, several hemostatic molecular markers, and antithrombin therapy have been recently developed for the diagnosis and treatment of thrombosis.

Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study

“…Especially under critical situations like sepsis or systemic inflammation, heparin could cause antithrombin consumption and degradation, as well as deleterious consequences due to the above reasons [10]. Patients with liver dysfunction may be accompanied by pathological changes like hyperfibrinolysis, accelerated intravascular coagulation, defected platelet (quantitatively and qualitatively), decreased synthesis of procoagulant and anticoagulant factors, as well as decreased clearance of activated factors [26,27]. These pathological changes could contribute to developing hemorrhagic complications when using any type of extracorporeal support with systemic anticoagulation.…”

Increased thrombin generation in splanchnic vein thrombosis is related to the presence of liver cirrhosis and not to the thrombotic event

“…Impaired liver function, as in chronic liver disease (CLD), results in thrombocytopenia, low levels of many procoagulant and anticoagulant factors and changes in fibrinolysis [2][3][4][5] and is reflected by the Child-Pugh (CP) class [6,7].…”

A quantitative model to predict blood use in adult orthotopic liver transplantation

“…All the coagulation factors affected by warfarin are synthesized and modified in the liver with vitamin K as a cofactor. Since liver diseases impact the synthesis of a broad spectrum of coagulation factors as well as the carboxylation of vitamin K dependent factors [51], elevated INRs may effectively reflect the hypocoagulable status in most OLT candidates. The hemoglobin level can potentially be modified preoperatively.…”