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Coagulation in cirrhosis

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https://www.readbyqxmd.com/read/28342265/efficacy-and-safety-of-edoxaban-for-treatment-of-portal-vein-thrombosis-following-danaparoid-sodium-in-patients-with-liver-cirrhosis
#1
Yuko Nagaoki, Hiroshi Aikata, Kana Daijo, Yuji Teraoka, Fumi Shinohara, Yuki Nakamura, Masahiro Hatooka, Kei Morio, Takashi Nakahara, Tomokazu Kawaoka, Masataka Tsuge, Akira Hiramatsu, Michio Imamura, Yoshiiku Kawakami, Hidenori Ochi, Kazuaki Chayama
AIM: To compare the efficacy and safety of edoxaban and warfarin for treatment of portal vein thrombosis (PVT) following danaparoid sodium in patients with liver cirrhosis. METHODS: Fifty cirrhotic patients with PVT treated initially for 2 weeks by danaparoid sodium were enrolled in this retrospective cohort study. Treatment was later switched to either edoxaban (n = 20) or warfarin (n = 30). We compared the efficacy and safety of edoxaban and warfarin for up to 6 months...
March 24, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28288507/anticoagulation-in-cirrhosis-a-new-paradigm
#2
Filippo Leonardi, Nicola De Maria, Erica Villa
The liver plays a crucial role in coagulation cascade. Global hemostatic process is profoundly influenced by the presence of liver disease and its complications. Patients with cirrhosis have impaired synthesis of most of the factors involved in coagulation and fibrinolysis process due to a reduced liver function and altered platelet count secondary to portal hypertension. Altered routine tests and thrombocytopenia were considered in the past as associated with increased risk of bleeding. These concepts explain both the routine use of plasma and/or platelets transfusion in patients with liver cirrhosis, especially before invasive procedures, and why these patients were considered "auto-anticoagulated"...
March 14, 2017: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/28245861/liver-radiofrequency-ablation-as-emergency-treatment-for-a-ruptured-hepatocellular-carcinoma-a-case-report
#3
Alessandra Bertacco, Francesco D'Amico, Maurizio Romano, Michele Finotti, Alessandro Vitale, Umberto Cillo
BACKGROUND: Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies. CASE PRESENTATION: We present a case report of a 78-year-old white man with alcoholic-related cirrhosis and a multifocal hepatocellular carcinoma. An abdominal computed tomography scan showed multiple and bilateral foci of bleeding from broken liver cancer. He was urgently transferred from our radiology unit to our operating room for massive hemoperitoneum...
March 1, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28241780/thromboelastometry-versus-standard-coagulation-tests-versus-restrictive-protocol-to-guide-blood-transfusion-prior-to-central-venous-catheterization-in-cirrhosis-study-protocol-for-a-randomized-controlled-trial
#4
Leonardo Lima Rocha, Camila Menezes Souza Pessoa, Ary Serpa Neto, Rogerio Ruscitto do Prado, Eliezer Silva, Marcio Dias de Almeida, Thiago Domingos Correa
BACKGROUND: Liver failure patients have traditionally been empirically transfused prior to invasive procedures. Blood transfusion is associated with immunologic and nonimmunologic reactions, increased risk of adverse outcomes and high costs. Scientific evidence supporting empirical transfusion is lacking, and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far. The aim of this study is to compare three transfusion strategies (routine coagulation test-guided - ordinary or restrictive, or thromboelastometry-guided) prior to central venous catheterization in critically ill patients with cirrhosis...
February 27, 2017: Trials
https://www.readbyqxmd.com/read/28217887/gastric-antral-vascular-ectasia-in-systemic-sclerosis-where-do-we-stand
#5
REVIEW
Hala El-Gendy, Kyrillus S Shohdy, Gehad G Maghraby, Kerolos Abadeer, Moustafa Mahmoud
Gastric antral vascular ectasia (GAVE) continues to be a challenge in both diagnosis and treatment. GAVE has a diverse group of associations and presumed causes, including cirrhosis, chronic renal failure and autoimmune connective tissue diseases. However, in most occasions, the management plan of GAVE itself is the same whatever the underlying disease by using Argon plasma coagulation (APC). Herein, we will discuss three cases of systemic sclerosis-associated GAVE presenting with either acute or chronic gastrointestinal bleeding showing variable responses to APC...
February 20, 2017: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/28166812/efficacy-of-high-intensity-focused-ultrasound-assisted-hepatic-resection-hifu-ar-on-blood-loss-reduction-in-patients-with-liver-metastases-requiring-hepatectomy-study-protocol-for-a-randomized-controlled-trial
#6
Aurélien Dupré, David Pérol, Ellen Blanc, Patrice Peyrat, Valéria Basso, Yao Chen, Jérémy Vincenot, Anthony Kocot, David Melodelima, Michel Rivoire
BACKGROUND: Liver resection is the only potentially curative treatment for colorectal liver metastases (LM). It is considered a safe procedure, but is often associated with blood loss during liver transection. Blood transfusions are frequently needed, but they are associated with increased morbidity and risk of recurrence. Many surgical devices have been developed to decrease blood loss. However, none of them has proven superior to the standard crushing technique. We developed a new, powerful intra-operative high-intensity focused ultrasound (HIFU) transducer which destroys tissue by coagulative necrosis...
February 6, 2017: Trials
https://www.readbyqxmd.com/read/28129465/evaluation-of-coagulation-during-treatment-with-directly-acting-antivirals-in-patients-with-hepatitis-c-virus-related-cirrhosis
#7
Armando Tripodi, Roberta D'Ambrosio, Lidia Padovan, Giulia Tosetti, Alessio Aghemo, Massimo Primignani, Veena Chantarangkul, Flora Peyvandi, Massimo Colombo
BACKGROUND & AIMS: The effect of direct-acting-antivirals (DAA) on coagulation of hepatitis-C-virus (HCV)-related cirrhosis is unknown. METHODS: We investigated 28 patients on DAA treatment and performed prothrombin-time, thrombin generation with and without thrombomodulin, whole-blood thromboelastometry, as well as the individual procoagulants (II, VIII, XIII, von Willebrand) and anticoagulants, antithrombin and protein-C. RESULTS: Patients had undetectable HCV-RNA at the end-of- treatment and at 12-weeks after end-of-treatment (sustained virological response)...
January 27, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28079670/impact-of-genetic-variation-in-the-vasopressin-1a-receptor-on-the-development-of-organ-failure-in-patients-admitted-for-acute-decompensation-of-liver-cirrhosis
#8
Annarein J C Kerbert, Jelte J Schaapman, Johan J van der Reijden, Àlex Amorós Navarro, Aiden McCormick, Bart van Hoek, Vicente Arroyo, Pere Ginès, Rajiv Jalan, Victor Vargas, Rudolf Stauber, Hein W Verspaget, Minneke J Coenraad
BACKGROUND: Vasopressin receptor-mediated vasoconstriction is considered to be involved in the pathogenesis of organ failure in acute-on-chronic liver failure (ACLF). PATIENTS AND METHODS: We studied the association between six single nucleotide polymorphisms (SNPs) of the vasopressin 1a receptor gene and the development of organ failure in 826 patients admitted for acute decompensation of liver cirrhosis (n=641) or ACLF (n=185). RESULTS: No associations were found for SNPs with the presence of circulatory or renal failure...
January 10, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28063764/plasma-transfusion-in-patients-with-cirrhosis-in-china-a-retrospective-multicenter-cohort-study
#9
REVIEW
Yao Lu, Guixiang Sun, Xiangfu Liu, Zhiguo Liu, Jianguo Tan, Yiwen Hao, Guiqiu Shan, Qun Luo, Deqing Wang, Yanchao Xing, Xianqing Zhang, Jiwu Gong, Simon J Stanworth, Jun Wang, Aiqing Wen
Patients with cirrhosis used to be associated with frequent use of blood components because of their complex disorder of hemostasis and bleeding complications. Recent findings have indicated that patients with cirrhosis have a state of "rebalanced" or even procoagulant hemostasis and have questioned the prophylactic use of plasma. To evaluate the current status of plasma use in patients with cirrhosis, we conducted a retrospective survey in 11 tertiary-care hospitals in China from September 1 to October 31, 2013...
December 2, 2016: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/27984558/the-impact-of-ledipasvir-sofosbuvir-on-hiv-positive-and-hiv-negative-japanese-hemophilia-patients-with-1-4-and-mixed-genotype-hcv
#10
Azusa Nagao, Hideji Hanabusa
INTRODUCTION: About 80% of patients with hemophilia who received non-heated coagulation factor concentrates in the early 1980s were infected with hepatitis C virus (HCV), and about 40% of them were infected with human immunodeficiency virus (HIV). AIM: We evaluated the efficacy and safety of administering ledipasvir (LDV)/sofosbuvir (SOF) to Japanese hemophilia patients. METHODS: Forty-three hemophilia patients with genotype 1 or 4 HCV were treated with LDV/SOF for 12 weeks...
December 7, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/27974342/use-of-thromboelastography-in-the-management-of-liver-cirrhosis-and-accelerated-intravascular-coagulation-and-fibrinolysis-aicf
#11
Thomas Joseph Peterson, Allison Margaret Brown Webb, Benjamin Samuel Vipler
In the presented case, the authors describe an obese middle-aged man that presented to the emergency department for persistent oedema, scleral icterus and fatigue. He was admitted to the hospital and diagnosed with liver cirrhosis via transjugular liver biopsy. He continued to bleed from the biopsy site for 5 days from accelerated intravascular coagulation and fibrinolysis (AICF) requiring multiple transfusions of packed red blood cells, fresh-frozen plasma and cryoprecipitate. The authors then used thromboelastography (TEG) to further characterise the patient's coagulopathy, which revealed platelet inhibition...
December 14, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27843428/a-rare-case-of-gastric-variceal-hemorrhage-secondary-to-infiltrative-b-cell-lymphoma
#12
Adrienne Lenhart, Juan Fernandez-Castillo, Keith Mullins, Reena Salgia
Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena...
September 2016: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/27833495/postoperative-pain-management-of-liver-transplantation-in-cystic-fibrosis-is-it-time-to-start-us-guided-neuraxial-blocks
#13
M Piazza, G Martucci, A Arcadipane
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27784425/-risk-factors-for-early-rebleeding-after-esophageal-variceal-ligation-in-patients-with-liver-cirrhosis
#14
J N Zhou, Z Wei, Z Q Sun
Objective: To investigate the risk factors for early rebleeding after esophageal variceal ligation (EVL) through a multicenter retrospective study. Methods: A total of 3289 patients who were hospitalized and underwent EVL in 17 upper second-class hospitals or hospitals of higher classes from January 1999 to May 2015 were collected and screened according to the exclusion criteria. A total of 2531 patients were screened out, and a retrospective analysis was performed for their clinical data including age, sex, endoscopic findings, and results of laboratory examination (liver function, biochemical results, routine blood test, and coagulation function) to collect related data...
July 20, 2016: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/27755254/risk-factors-associated-with-complications-in-cirrhotic-patients-undergoing-endoscopic-retrograde-cholangio-pancreatography
#15
Ricardo U Macías-Rodríguez, Astrid Ruiz-Margáin, Jose L Rodriguez-Garcia, Sergio Zepeda-Gómez, Aldo Torre
OBJECTIVE: Endoscopic retrograde cholangio-pancreatography (ERCP) is useful for the management of biliary tract diseases; in patients with cirrhosis, portal hypertension may increase the risk for complications from ERCP. We evaluated the outcome and risk factors related to ERCP in patients with cirrhosis and portal hypertension. PATIENTS AND METHODS: In this case-control study, 37 patients (71 procedures) with cirrhosis and portal hypertension (group 1) and 37 controls (group 2) undergoing ERCP were included...
February 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27722160/monitoring-and-treatment-of-coagulation-disorders-in-end-stage-liver-disease
#16
REVIEW
Fuat H Saner, Carmen Kirchner
BACKGROUND: Patients with end-stage liver disease (ESLD) are assumed to be at high risk of bleeding when undergoing any kind of invasive intervention (any kind of operation, including transplantation or minimally invasive interventions). Both bleeding and thrombosis are associated with a poor outcome. METHODS: A selective literature research was conducted with the following key words: 'cirrhosis', 'coagulation', 'bleeding', 'INR' (international normalized ratio), 'aPTT' (activated partial thromboplastin time), and 'thrombocytopenia'...
August 2016: Visceral Medicine
https://www.readbyqxmd.com/read/27683637/thromboelastographic-reference-ranges-for-a-cirrhotic-patient-population-undergoing-liver-transplantation
#17
Lesley De Pietri, Marcello Bianchini, Gianluca Rompianesi, Elisabetta Bertellini, Bruno Begliomini
AIM: To describe the thromboelastography (TEG) "reference" values within a population of liver transplant (LT) candidates that underline the differences from healthy patients. METHODS: Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease (MELD) score between 15 and 40 were studied. In particular the adult patients (aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded...
September 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/27682708/the-outcome-of-seven-patients-with-hereditary-tyrosinemia-type-1
#18
Songul Gokay, Pembe Soylu Ustkoyuncu, Fatih Kardas, Mustafa Kendirci
BACKGROUND: Hereditary tyrosinemia type 1 (HT1) is a rare, inborn error of tyrosine metabolism. It is a fatal disorder without treatment. Early treatment may prevent acute liver failure, renal dysfunction, liver cirrhosis, hepatocellular carcinoma (HCC) and improves survival. The aim of the present study is to describe the clinical, biochemical, imaging and follow-up of seven patients with HT1 and to define the consequences of the late and interrupted treatment. METHODS: A retrospective study was carried out with seven HT1 patients...
October 1, 2016: Journal of Pediatric Endocrinology & Metabolism: JPEM
https://www.readbyqxmd.com/read/27677683/oral-surgical-treatment-of-patients-with-chronic-liver-disease-assessments-of-bleeding-and-its-relationship-with-thrombocytopenia-and-blood-coagulation-parameters
#19
Nadia Cocero, Marta Bezzi, Silvia Martini, Stefano Carossa
PURPOSE: Cirrhotic patients awaiting liver transplantation require eradication of infectious oral foci to prevent septic episodes after transplantation; however, cirrhosis can hinder hemostasis and can result in severe bleeding. The present study assessed the bleeding risk factors connected with the clinical history of these patients and the characteristics of the extractions. MATERIALS AND METHODS: We retrospectively analyzed 1183 extractions in 318 patients, including 47 with severe end-stage liver disease who were outside of our intention-to-treat bracket (ie, platelet count [PLT] >40 × 10(3)/μL and international normalized ratio [INR] <2...
January 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27659187/a-case-report-of-simultaneous-orthotopic-liver-transplantation-and-jejunectomy
#20
Guoyong Chen, Sidong Wei, Zhongwu Zou, Jianjun Sun, Gaofeng Tang, Jianbin Chen, Shaotang Zhou
BACKGROUND: Liver transplantation (LT) accompanied by jejunectomy to treat patients with acute or chronic hepatic cirrhosis with thrombosis in the portal system is extremely rare. CASE PRESENTATION: A 47-year-old man presented with hematemesis and melena, and a diagnosis of decompensated cirrhosis, chronic portal vein thrombosis (PVT) and secondary gastro-esophageal variceal hemorrhage was made. Coagulants were administered, but portal vein thrombi occurred rapidly, and gastrointestinal bleeding recurred shortly thereafter...
2016: BMC Surgery
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