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Coagulation in cirrhosis

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https://www.readbyqxmd.com/read/28509781/correction-of-severe-coagulopathy-and-hyperfibrinolysis-by-tranexamic-acid-and-recombinant-factor-viia-in-a-cirrhotic-patient-after-trauma-a-case-report
#1
Jack Louro, Katherine Andersen, Roman Dudaryk
Coagulopathy induced by trauma or cirrhosis is a well-recognized entity. Viscoelastic testing has been used in either condition for goal-directed transfusion and detection of fibrinolysis since conventional coagulation tests do not correlate with clinical risk of bleeding. Hemostatic resuscitation may not be adequate for a trauma patient with liver disease due to complex alterations in coagulation systems and occasionally require adjuvant therapy. We report a case of trauma-induced coagulopathy presenting as severe hyperfibrinolysis in a cirrhotic patient who was refractory to hemostatic resuscitation but was rapidly corrected by the administration of tranexamic acid and recombinant Factor VIIa...
May 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28496539/efficacy-and-safety-of-direct-acting-oral-anticoagulants-use-in-acute-portal-vein-thrombosis-unrelated-to-cirrhosis
#2
Filipe Nery, Diana Valadares, Sara Morais, Manuel Teixeira Gomes, Andrea De Gottardi
In acute portal vein thrombosis (APVT) unrelated to cirrhosis, anticoagulant therapy is classically started with low molecular weight heparin or vitamin K antagonists. New direct-acting oral anticoagulants (DOACs) are used in the treatment of venous thrombosis outside the splanchnic vascular bed, but not in the latter. We report a young female with APVT occurring in a non-cirrhotic liver linked to heterozygosity of factor V-Leiden and prothrombin G20210A gene mutations. Rivaroxaban was started, with total recanalization of the left and partial recanalization of the right portal vein branches, without complications...
April 2017: Gastroenterology Research
https://www.readbyqxmd.com/read/28489255/increased-risk-of-portal-vein-thrombosis-in-patients-with-autoimmune-hepatitis-on-the-liver-transplantation-waiting-list
#3
Pablo Ruiz, Lydia Sastre, Gonzalo Crespo, Annabel Blasi, Jordi Colmenero, Juan Carlos García-Valdecasas, Miquel Navasa
Liver transplantation (LT) is indicated in autoimmune hepatitis (AIH) for both acute presentation with liver failure and end-stage chronic liver disease. Few studies have suggested an association between AIH and coagulation disorders and a higher incidence of portal vein thrombosis (PVT) in patients with AIH listed for LT. The aim of this study was to determine the incidence of thrombotic complications, particularly PVT, in a cohort of 37 patients undergoing LT because of AIH. PVT was present before transplantation in 30% (n=11) of these patients compared to 11% in the whole population transplanted in our centre (p=0...
May 10, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28472132/decreased-prothrombin-conversion-and-reduced-thrombin-inactivation-explain-rebalanced-thrombin-generation-in-liver-cirrhosis
#4
Romy M W Kremers, Marie-Claire Kleinegris, Marisa Ninivaggi, Bas de Laat, Hugo Ten Cate, Ger H Koek, Rob J Wagenvoord, H Coenraad Hemker
Impaired coagulation factor synthesis in cirrhosis causes a reduction of most pro- and anticoagulant factors. Cirrhosis patients show no clear bleeding or thrombotic phenotype, although they are at risk for both types of hemostatic event. Thrombin generation (TG) is a global coagulation test and its outcome depends on underlying pro- and anticoagulant processes (prothrombin conversion and thrombin inactivation). We quantified the prothrombin conversion and thrombin inactivation during TG in 30 healthy subjects and 52 Child-Pugh (CP-) A, 15 CP-B and 6 CP-C cirrhosis patients to test the hypothesis that coagulation is rebalanced in liver cirrhosis patients...
2017: PloS One
https://www.readbyqxmd.com/read/28427335/cholesterol-esterification-in-plasma-as-a-biomarker-for-liver-function-and-prediction-of-mortality
#5
Thorsten Kaiser, Benedict Kinny-Köster, Michael Bartels, Thomas Berg, Markus Scholz, Cornelius Engelmann, Daniel Seehofer, Susen Becker, Uta Ceglarek, Joachim Thiery
BACKGROUND: Advanced stages of liver cirrhosis lead to a dramatically increased mortality. For valid identification of these patients suitable biomarkers are essential. The most important biomarkers for liver function are bilirubin and prothrombin time expressed as International Normalized Ratio (INR). However, the influence of several anticoagulants on the prothrombin time limits its diagnostic value. Aim of this study was the evaluation of cholesterol esterification (CE) fraction (esterified cholesterol vs...
April 20, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/28350742/short-article-impact-of-genetic-variation-in-the-vasopressin-1a-receptor-on-the-development-of-organ-failure-in-patients-admitted-for-acute-decompensation-of-liver-cirrhosis
#6
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...
May 2017: European Journal of Gastroenterology & Hepatology
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
#7
Yuko Nagaoki, Hiroshi Aikata, Kana Daijyo, 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 with 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
#8
REVIEW
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 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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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