Laboratory evidence for hypercoagulability in cirrhotic patients with history of variceal bleeding

Rogalski, Paweł; Rogalska, Magdalena; Wróblewski, Eugeniusz; Kostecka-Roslen, Ines; Dąbrowska, Milena; Świdnicka-Siergiejko, Agnieszka Katarzyna; Wasielica-Berger, Justyna; Cydzik, Mariusz; Hirnle, Tomasz; Flisiak, Robert; Dâbrowski, A

doi:10.1016/j.thromres.2019.03.021

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…The mortality of the first bleeding was about 20-30% if an active intervention was not carried out (4). Within 2 years after the first bleeding, the rebleeding rate and mortality increased significantly, which threatened the safety of patients (5).…”

Section: Introductionmentioning

confidence: 99%

“…The mortality of the first bleeding was about 20–30% if an active intervention was not carried out ( 4 ). Within 2 years after the first bleeding, the rebleeding rate and mortality increased significantly, which threatened the safety of patients ( 5 ). However, the secondary prevention of EVB in liver cirrhosis mainly includes endoscopic treatment, non-selective beta-blocker drugs (NSBBs), transjugular intrahepatic portosystemic shunt (TIPS), and surgical treatment ( 6 ); all these methods have limited curative effects.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

Su¹,

Zhang²,

Ren³

et al. 2021

Front. Surg.

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Objective: To evaluate the efficacy and safety of endoscopic variceal ligation + endoscopic injection sclerotherapy (EVL+EIS) to control acute variceal bleeding (AVB).Methods: Online databases, including Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) disc, VIP, and Wanfang, were searched to identify the studies comparing the differences between EVB+EIS and EVB, EIS from the inception of the databases up to December 30, 2020. STATA 13.0 was used for the meta-analysis.Results: A total of eight studies involving 595 patients (317 patients in the EVL group and 278 patients in the EVL+EIS group) were included. The results of the meta-analysis did not reveal any statistically significant differences in the efficacy of acute bleeding control (P = 0.981), overall rebleeding (P = 0.415), variceal eradication (P = 0.960), and overall mortality (P = 0.314), but a significant difference was noted in the overall complications (P = 0.01).Conclusion: EVL is superior to the combination of EVL and EIS in safety, while no statistically significant differences were detected in efficacy. Further studies should be designed with a large sample size, multiple centers, and randomized controlled trials to assess both clinical interventions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

Su¹,

Zhang²,

Ren³

et al. 2021

Front. Surg.

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“…13 This disparity indicates that the clinical outcome depends not only on successful stopping of bleeding, but primarily on the severity of underlying chronic liver disease and the development of complications. 14,15 Acuteon-chronic liver failure is one such complication which potentially can contribute to increased mortality after GIB. Gastrointestinal hemorrhage is a known trigger of ACLF.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients

Rogalski¹,

Zaborowska²,

Mazur³

et al. 2022

Adv Clin Exp Med

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Background. Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failures and very high short-term mortality. Objectives.To assess the incidence and factors predisposing to ACLF in patients with liver cirrhosis hospitalized due to acute gastrointestinal bleeding (GIB). Materials and methods.We collected and retrospectively analyzed the data of 89 consecutive patients (59 males (66.2%), median age 53 years (range: 44-62 years), mean Model for End-Stage Liver Disease (MELD) score 14.42 ±6.5, median Child-Turcotte-Pugh score 10 (range: 8-11), and acute GIB (72 variceal bleeding and 17 non-variceal bleeding cases). Acute-on-chronic liver failure was diagnosed based on European Association for the Study of the Liver -Chronic Liver Failure Consortium definition.Results. Twenty-seven (30.33%) patients met the criteria of ACLF during hospitalization: 8 (30%) had ACLF grade 1, 13 (48%) had ACLF grade 2 and 6 (22%) had ACLF grade 3. The most frequent organ failures were respiratory (22 (25%)), kidney (18 (20.23%)) and brain (17 (19. 1%)) failure. The MELD score value, creatinine level and presence of hepatic encephalopathy (HE) on admission were significant predictors of ACLF in the multivariate logistic regression model with optimal cutoff point for MELD score of 18.313 and optimal cutoff point for creatinine level of 1.35 mg/dL. Conclusions.In-hospital risk of ACLF in cirrhotic patients hospitalized for acute gastrointestinal hemorrhage is high despite successful arrest of bleeding. Elevated creatinine level, MELD score and the presence of HE on admission are the best predictors of ACLF during hospitalization in such patients.

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“…Variceal bleeding in cirrhotic patients is mainly due to high portal pressure and not directly correlated with hemostatic abnormalities. 43 Standard approaches to manage portal hypertension, endoscopic treatment and a restrictive transfusion policy are recommended. In decompensated patients non-variceal bleeding also remains a frequent clinical problem.…”

Section: Spontaneous/procedural Bleedingmentioning

confidence: 99%

The use of prothrombin complex concentrate in chronic liver disease: A review of the literature

Dievoet

Stéphenne

Rousseaux

et al. 2023

Transfusion Medicine

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Patients with chronic liver disease (CLD) and cirrhosis present a rebalanced hemostatic system in the three phases of haemostasis. This balance is however unstable and can easily tip towards bleeding or thrombosis. Management of both spontaneous bleeding and bleeding during invasive procedures remains a challenge in this patient population. Transfusion of blood products can result in circulatory overload and thereby worsen portal hypertension. As an alternative to fresh frozen plasma (FFP), prothrombin complex concentrates (PCC) may have merit in patients with liver disease because of their low volume. The impact of PCC in in‐vitro spiking experiments of cirrhotic plasma is promising, but also warrants cautious use in light of thromboembolic risk. The majority of existing studies carried‐out in CLD patients are retrospective or do not have an adequate control arm. A prospective study (the PROTON trial) was set up in 2013 to investigate the utility of PCC in patients undergoing liver transplantation. However, the study has never recruited the planned number of patients. Robust data on PCC safety in CLD is also required. The limited existing evidence does not seem to indicate an excessive thromboembolic risk. Currently, the utilisation of PCC in CLD cannot be routinely recommended but can provide an option for carefully selected cases in which other measures were not sufficient to control bleeding and after delicately weighing risks and benefits.

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Laboratory evidence for hypercoagulability in cirrhotic patients with history of variceal bleeding

Cited by 8 publications

References 16 publications

Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

Gastrointestinal hemorrhage as an acute-on-chronic liver failure trigger in cirrhotic patients

The use of prothrombin complex concentrate in chronic liver disease: A review of the literature

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