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https://www.readbyqxmd.com/read/27917713/antiplatelets-and-antithrombotics-in-patients-with-liver-insufficiency-from-pathophysiology-to-clinical-practice
#1
Melanie Deutsch, John Koskinas
The liver represents the site of synthesis of most procoagulant and anticoagulant factors, fibrinolytic proteins and thrombopoetin while being also involved in the clearance of hemostatic and fibrinolyic proteins. Therefore in patients with liver insufficiency a great variety of disturbances can be documented resulting however in a new "rebalanced" hemostatic system with a labile equilibrium between thromboses or bleeding. Interestingly patients with liver insufficiency may present with arterial or venous thrombotic episodes requiring antiplatelet and/or antithrombotic therapy despite low platelet count or prolonged INR...
December 5, 2016: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/27099538/new-developments-in-the-management-of-moderate-to-severe-hemophilia-b
#2
REVIEW
Moniba Nazeef, John P Sheehan
Hemophilia B is an X-linked genetic deficiency of coagulation factor IX (FIX) activity associated with recurrent deep tissue and joint bleeding that may lead to long-term disability. FIX replacement therapy using plasma-derived protein or recombinant protein has significantly reduced bleeding and disability from hemophilia B, particularly when used in a prophylactic fashion. Although modern factor replacement has excellent efficacy and safety, barriers to the broader use of prophylaxis remain, including the need for intravenous (IV) access, frequent dosing, variability in individual pharmacokinetics, and cost...
2016: Journal of Blood Medicine
https://www.readbyqxmd.com/read/27060337/role-of-hemostatic-factors-in-hepatic-injury-and-disease-animal-models-de-liver
#3
REVIEW
A K Kopec, N Joshi, J P Luyendyk
Chronic liver damage is associated with unique changes in the hemostatic system. Patients with liver disease often show a precariously rebalanced hemostatic system, which is easily tipped towards bleeding or thrombotic complications by otherwise benign stimuli. In addition, some clinical studies have shown that hemostatic system components contribute to the progression of liver disease. There is a strong basic science foundation for clinical studies with this particular focus. Chronic and acute liver disease can be modeled in rodents and large animals with a variety of approaches, which span chronic exposure to toxic xenobiotics, diet-induced obesity, and surgical intervention...
July 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/26978811/-not-available
#4
Rupesh Rajani, Hanns-Ulrich Marschall
Patients with acute and chronic liver disease have a rebalanced hemostasis, i.e. these patients have an increased tendency for both bleeding and thrombosis.Bleeding is primarily related to portal hypertension, rather than a defective hemostasis. There are well-established clinical guidelines for the management of patients with liver cirrhosis and variceal bleeding.Epidemiological studies have demonstrated an increased risk of venous thromboembolism in patients with liver cirrhosis. The treatment of patients with liver cirrhosis and venous thrombosis is not well documented...
2016: Läkartidningen
https://www.readbyqxmd.com/read/26877606/coagulopathy-and-transfusion-therapy-in-pediatric-liver-transplantation
#5
REVIEW
Mirco Nacoti, Davide Corbella, Francesco Fazzi, Francesca Rapido, Ezio Bonanomi
Bleeding and coagulopathy are critical issues complicating pediatric liver transplantation and contributing to morbidity and mortality in the cirrhotic child. The complexity of coagulopathy in the pediatric patient is illustrated by the interaction between three basic models. The first model, "developmental hemostasis", demonstrates how a different balance between pro- and anticoagulation factors leads to a normal hemostatic capacity in the pediatric patient at various ages. The second, the "cell based model of coagulation", takes into account the interaction between plasma proteins and cells...
February 14, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/26819521/hemostasis-in-liver-transplantation-pathophysiology-monitoring-and-treatment
#6
REVIEW
Matthias Hartmann, Cynthia Szalai, Fuat H Saner
Recent findings in the pathophysiology and monitoring of hemostasis in patients with end stage liver disease have major impact on coagulation management during liver transplantation. There is increasing evidence, that the changes in both coagulation factors and platelet count regularly observed in patients with liver cirrhosis cannot be interpreted as a reliable indicator of diffuse bleeding risk. Instead, a differentiated view on hemostasis has led to the concept of a rebalanced coagulation system: While it is important to recognize that procoagulant factors are reduced in liver cirrhosis, it is also evident that synthesis of anticoagulant factors and fibrinolytic proteins produced in the liver is also diminished...
January 28, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/26689354/therapeutic-and-clinical-aspects-of-portal-vein-thrombosis-in-patients-with-cirrhosis
#7
REVIEW
Massimo Primignani, Giulia Tosetti, Vincenzo La Mura
Portal vein thrombosis (PVT) is a frequent complication in cirrhosis, particularly in advanced stages of the disease. As for general venous thromboembolism, risk factors for PVT are slow blood flow, vessel wall damage and hypercoagulability, all features of advanced cirrhosis. Actually, the old dogma of a hemorrhagic tendency in cirrhosis has been challenged by new laboratory tools and the clinical evidence that venous thrombosis also occurs in cirrhosis. The impaired hepatic synthesis of both pro- and anticoagulants leads to a rebalanced hemostasis, more liable to be tipped towards thrombosis or even bleeding...
December 18, 2015: World Journal of Hepatology
https://www.readbyqxmd.com/read/26637729/coagulopathy-in-liver-disease-a-balancing-act
#8
Jody L Kujovich
Liver disease results in complex alterations of all 3 phases of hemostasis. It is now recognized that hemostasis is rebalanced in chronic liver disease. The fall in clotting factor levels is accompanied by a parallel fall in anticoagulant proteins. High von Willebrand factor levels counteract defects in primary hemostasis. Conventional coagulation tests do not fully reflect the derangement in hemostasis and do not accurately predict the risk of bleeding. Global coagulation assays (thrombin generation, thromboelastography) reflect the interaction between procoagulant factors, anticoagulant factors, platelets, and the fibrinolytic system and show promise for assessing bleeding risk and guiding therapy...
2015: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/26546358/immune-thrombocytopenic-purpurae-presenting-with-cortical-vein-thrombosis-is-it-rebalanced-hemostasis
#9
COMMENT
Manoj Lakhotia, Hans Raj Pahadiya, Ronak Gandhi, Shashank Bhansali
No abstract text is available yet for this article.
February 2016: Annals of Hematology
https://www.readbyqxmd.com/read/26207163/spontaneous-bleeding-or-thrombosis-in-cirrhosis-what-should-be-feared-the-most
#10
Kryssia Isabel Rodríguez-Castro, Alessandro Antonello, Alberto Ferrarese
The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being "auto-anticoagulated", prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications...
July 18, 2015: World Journal of Hepatology
https://www.readbyqxmd.com/read/26080306/liver-disease-and-hemostatic-dys-function
#11
REVIEW
Armando Tripodi
Cirrhosis presents with decreased procoagulant factors as a consequence of the impaired synthetic capacity of the liver. This was taken as evidence to explain the abnormalities of the coagulation tests prothrombin time (PT) and activated partial thromboplastin time (aPTT) and the bleeding events that occur in these patients. It was for long time (and probably is still) common practice to test patients with the PT and to treat those with predefined (but arbitrary) cutoff values with plasma or prohemostatic agents to prevent or stop bleeding...
July 2015: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/26080305/management-of-bleeding-and-thrombosis-in-critically-ill-patients-with-liver-disease
#12
REVIEW
Lara N Roberts, William Bernal
Bleeding frequently complicates end-stage chronic liver disease, and may follow procedures which are required for effective care of patients with liver failure. Thrombosis is increasingly recognized as common, important, and potentially preventable. Standard laboratory tests may not be useful in predicting bleeding or thrombotic risk or guiding therapy, and functional testing serves a more useful role. A state of rebalanced hemostasis exists in many patients, with hypocoagulability present only in a minority...
July 2015: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/26049072/clinical-utility-of-viscoelastic-tests-of-coagulation-teg-rotem-in-patients-with-liver-disease-and-during-liver-transplantation
#13
REVIEW
Susan V Mallett
The concept that patients with stable liver disease are at an increased risk of bleeding, based solely on abnormalities of conventional coagulation tests such as prothrombin time (PT) and international normalized ratio (INR), is now recognized to be an overly simplistic interpretation of an extremely complex situation. These tests are in fact very poor predictors of bleeding in patients with liver disease who undergo invasive or surgical procedures. Commercially available whole blood viscoelastic tests (thromboelastography [TEG] and thromboelastometry [ROTEM]) evaluate the kinetics of coagulation from initial clot formation to final clot strength...
July 2015: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/26049071/rebalanced-hemostasis-in-patients-with-acute-liver-failure
#14
REVIEW
Ton Lisman, R Todd Stravitz
Patients with acute liver failure (ALF) have substantial alterations in their hemostatic system. Since an international normalized ratio of ≥ 1.5 is part of the definition of the syndrome, it has long been believed that patients with ALF had a hemostasis-related bleeding tendency. Recent data, however, show that spontaneous bleeding in ALF is rare. In addition, thrombotic complications may be more common than spontaneous bleeding complications. Laboratory studies have suggested that patients with ALF may be in hemostatic balance as a result of a commensurate decline in pro- and anti-hemostatic factors...
July 2015: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/25370801/hemostatic-status-in-liver-transplantation-association-between-preoperative-procoagulants-anticoagulants-and-postoperative-hemorrhaging-thrombosis
#15
Nobuhisa Akamatsu, Yasuhiko Sugawara, Akiko Nakazawa, Yujiro Nishioka, Junichi Kaneko, Taku Aoki, Yoshihiro Sakamoto, Kiyoshi Hasegawa, Norihiro Kokudo
The delicate rebalanced hemostatic status of liver transplant recipients may lead to both hemorrhagic and thrombotic tendencies in this population. The aim of this study was to investigate the association between pretransplant procoagulants/anticoagulants and posttransplant bleeding and thrombosis among living donor liver transplant recipients. The study subjects were 403 consecutive recipients with chronic liver disease. Perioperative variables, including preoperative values for procoagulants and anticoagulants, were assessed to determine their association with posttransplant hemorrhaging and thrombosis...
February 2015: Liver Transplantation
https://www.readbyqxmd.com/read/24970667/management-of-coagulation-abnormalities-in-liver-disease
#16
REVIEW
Wilma Potze, Robert J Porte, Ton Lisman
Liver disease is characterized by changes in all phases of hemostasis. These hemostatic alterations were long considered to predispose patients with liver disease towards a bleeding tendency, as they are associated with prolonged conventional coagulation tests. However, these patients may also suffer from thrombotic complications, and we now know that the hemostatic system in patient with liver disease is, in fact, in a rebalanced state. In this review we discuss the concept of rebalanced hemostasis and its implications for clinical management of patients with liver disease...
January 2015: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/24721432/hemostasis-in-liver-disease-implications-of-new-concepts-for-perioperative-management
#17
REVIEW
Pepijn D Weeder, Robert J Porte, Ton Lisman
The hemostatic profile of patients with liver diseases is frequently profoundly different from that of healthy individuals. These complex alterations lead to abnormal results from routine laboratory tests, but because of the nature of these assays, they fail to accurately represent the patient's hemostatic state. Nevertheless, based on abnormal laboratory coagulation values, it has long been assumed that patients with liver disease have a natural bleeding tendency and are protected from thrombosis. This assumption is false; the average patient with liver disease is actually in a state of "rebalanced hemostasis" that can relatively easily be tipped toward both bleeding and thrombosis...
July 2014: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/24433238/rebalanced-hemostasis-in-patients-with-idiopathic-thrombocytopenic-purpura
#18
Won Ho Kim, Jung Bo Park, Chul Won Jung, Gaab Soo Kim
Previous laboratory and clinical data have shown evidence for the concept of rebalanced hemostasis in liver disease. We evaluate whether this concept of rebalanced hemostasis can be applied in patients with idiopathic thrombocytopenic purpura (ITP). Twenty patients with ITP (platelet count < 100 × 10(9) /l) who visited our hospital were enrolled. We measured the von Willebrand factor (vWF) antigen levels and performed native blood thromboelastography (TEG) to evaluate the hemostasis. As a subgroup analysis, we compared patients with elevated vWF levels with those with normal levels...
2015: Platelets
https://www.readbyqxmd.com/read/24164805/evidence-of-rebalanced-coagulation-in-acute-liver-injury-and-acute-liver-failure-as-measured-by-thrombin-generation
#19
Mohamed Habib, Lara N Roberts, Raj K Patel, Julia Wendon, William Bernal, Roopen Arya
BACKGROUND & AIMS: Patients with liver disease often show profound abnormalities in their haemostatic system. Studies using thrombin generation demonstrate rebalanced coagulation in patients with chronic liver disease. Our aim was to evaluate the haemostatic profile in patients with acute liver injury/failure (ALI/ALF) compared with healthy controls. METHODS: Thrombin generation was measured in the presence and absence of thrombomodulin (TM) to activate protein C (PC) with endogenous thrombin potential (ETP; the area under the thrombin generation curve) a key parameter...
May 2014: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/23506859/coagulation-in-liver-disease-a-guide-for-the-clinician
#20
REVIEW
Patrick G Northup, Stephen H Caldwell
The human hemostasis system is complex and poorly understood after decades of intense scientific study. Despite multiple defects in routine coagulation laboratory studies in patients with chronic liver disease, there is growing evidence that these patients are effectively "rebalanced" with regard to procoagulant and anticoagulant activity and that most of these patients remain in a tenuous but balanced state of hemostasis. A major difficulty in the assessment of these patients is that there are no established laboratory tests that accurately reflect the changes in both the procoagulant and anticoagulant systems; therefore, routine laboratory testing is misleading to the clinician and may prompt inappropriate or risky therapies with little real benefit to the patient...
September 2013: Clinical Gastroenterology and Hepatology
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