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Coagulation in cirrhosis

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https://www.readbyqxmd.com/read/29766340/the-cholic-acid-extension-study-in-zellweger-spectrum-disorders-results-and-implications-for-therapy
#1
Femke C C Klouwer, Bart G P Koot, Kevin Berendse, Elles M Kemper, Sacha Ferdinandusse, Kiran V K Koelfat, Martin Lenicek, Frédéric M Vaz, Marc Engelen, Peter L M Jansen, Ronald J A Wanders, Hans R Waterham, Frank G Schaap, Bwee Tien Poll-The
INTRODUCTION: Currently, no therapies are available for Zellweger spectrum disorders (ZSDs), a group of genetic metabolic disorders characterised by a deficiency of functional peroxisomes. In a previous study, we showed that oral cholic acid (CA) treatment can suppress bile acid synthesis in ZSD patients and, thereby, decrease plasma levels of toxic C27 -bile acid intermediates, one of the biochemical abnormalities in these patients. However, no effect on clinically relevant outcome measures could be observed after 9 months of CA treatment...
May 15, 2018: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/29757897/coagulation-defects-in-the-cirrhotic-patient-undergoing-liver-transplantation
#2
Arabesque Parker, Constantine J Karvellas
Patients with cirrhosis undergoing liver transplantation have unique challenges with regard to the prevention and management of thrombosis and hemorrhage. Patients with cirrhosis have an unstable balance of the coagulation system due to defects in both prothrombotic and antithrombotic components. These changes make laboratory monitoring challenging, prophylaxis against bleeding and thrombosis controversial, and therapy for the same uncertain. When cirrhotic patients undergo liver transplantation they frequently have significant transfusion requirements...
May 7, 2018: Transplantation
https://www.readbyqxmd.com/read/29723040/role-of-the-blood-coagulation-cascade-in-hepatic-fibrosis
#3
Asmita Pant, Anna K Kopec, James P Luyendyk
Liver is the primary source of numerous proteins critical for normal function of the blood coagulation cascade. Because of this, diseases of the liver, particularly when affiliated with severe complications like cirrhosis, are associated with abnormalities of blood clotting. Although conventional interpretation has inferred cirrhosis as a disorder of uniform bleeding risk, it is now increasingly appreciated as a disease wherein the coagulation cascade is precariously rebalanced. Moreover, prothrombotic risk factors are also associated with a more rapid progression of fibrosis in humans, suggesting that coagulation proteases participate in disease pathogenesis...
May 3, 2018: American Journal of Physiology. Gastrointestinal and Liver Physiology
https://www.readbyqxmd.com/read/29703920/prevalent-metabolic-derangement-and-severe-thrombocytopenia-in-abo-incompatible-liver-recipients-with-pre-transplant-plasma-exchange
#4
Hye-Mee Kwon, In-Gu Jun, JungBok Lee, Young-Jin Moon, Kyeo-Woon Jung, Hye-Won Jeong, Yong-Seok Park, Jun-Gol Song, Gyu-Sam Hwang
Desensitisation with therapeutic plasma exchange (TPE) is essential for ABO-incompatible (ABO-I) liver transplants (LTs). However, excessive citrate load and coagulation disturbances after TPE have been poorly studied, in particular in cirrhotic patients with hypocapnic alkalosis, metabolic compensation and electrolyte imbalances. We retrospectively evaluated 1123 consecutive LT recipients (923 ABO-compatible [ABO-C], 200 ABO-I) from November 2008 to May 2015. TPE was generally performed a day before LT and blood sampling was performed before anaesthesia induction...
April 27, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29699477/effects-of-bacterial-translocation-on-hemodynamic-and-coagulation-parameters-during-living-donor-liver-transplant
#5
Heba A Moharem, Fawzia Aboul Fetouh, Hamed M Darwish, Doaa Ghaith, Mohamed Elayashy, Amr Hussein, Riham Elsayed, Mohammad M Khalil, Amr Abdelaal, Mahmoud ElMeteini, Ahmed Mukhtar
BACKGROUND: Bacterial translocation (BT) has been proposed as a trigger for stimulation of the immune system with consequent hemodynamic alteration in patients with liver cirrhosis. However, no information is available regarding its hemodynamic and coagulation consequences during liver transplantation. METHODS: We screened 30 consecutive adult patients undergoing living-donor liver transplant for the presence of BT. Bacterial DNA, Anti factor Xa (aFXa), thromboelastometry, tumor necrosis factor-α TNF-α, and interleukin-17 (IL-17) values were measured in sera before induction of anesthesia...
April 25, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29623218/the-influence-of-a-peritoneovenous-shunt-for-cirrhotic-and-malignant-intractable-ascites-on-renal-function
#6
Takafumi Segawa, Kenichi Kato, Kazuya Kawashima, Tomohiro Suzuki, Shigeru Ehara
Background: Peritoneovenous shunts (PVS) are widely used for palliation of intractable ascites caused by peritoneal carcinomatosis (PC) or liver cirrhosis (LC). Some patients who need PVS have renal dysfunction. However, renal dysfunction is considered a relative contraindication. Therefore, it is important to assess renal function before PVS placement. Purpose: To evaluate the relationship between PVS and renal function. Material and Methods: Between October 2007 and July 2015, 60 patients (PC = 47; LC = 10; others = 3) underwent PVS placement for intractable ascites...
March 2018: Acta Radiologica Open
https://www.readbyqxmd.com/read/29620649/primary-medullary-hemorrhage-in-a-patient-with-coagulopathy-due-to-alcoholic-cirrhosis-a-case-report
#7
Guangxun Shen, Yu Gao, Kwee-Yum Lee, Guangxian Nan
RATIONALE: Mild-to-moderate alcoholic cirrhosis of the liver is related to spontaneous intracerebral hemorrhage (ICH). In terms of spontaneous brainstem hemorrhage, pontine is considered as the most common site in contrast to medulla oblongata where the hemorrhage is rarely seen. This rare primary medullary hemorrhage has been attributed so far to vascular malformation (VM), anticoagulants, hypertension, hemorrhagic transformation, and other undetermined factors. PATIENT CONCERNS: Herein, we describe a 53-year-old patient with 35-year history of alcohol abuse was admitted for acute-onset isolated hemianesthesia on the right side...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29605063/classification-and-epidemiologic-aspects-of-acute-liver-failure
#8
REVIEW
Daniel Pievsky, Neil Rustgi, Nikolaos T Pyrsopoulos
Acute liver failure is a rare condition with high short-term morbidity and mortality. The most widely accepted definition is an abnormality in coagulation with any degree of encephalopathy in a patient without cirrhosis and an illness duration of less than 26 weeks. Multiple classifications systems are currently in use to help categorize the condition. This article reviews the most commonly used systems. The epidemiologic aspects of the disease are also reviewed, including incidence, prevalence, demographics, geographic distribution, and racial and cultural factors and are discussed for the various subtypes of acute liver failure...
May 2018: Clinics in Liver Disease
https://www.readbyqxmd.com/read/29561276/the-primary-haemostasis-is-more-preserved-in-thrombocytopenic-patients-with-liver-cirrhosis-than-cancer
#9
Pernille Just Vinholt, Anne B Alnor, Mads Nybo, Anne-Mette Hvas
: In thrombocytopenia, differences in haemostatic capacity may explain discrepancies in bleeding risk between patients with cancer and patients with liver cirrhosis. The objective was to compare the haemostatic capacity in different thrombocytopenic patient populations. We evaluated platelet aggregation using impedance aggregometry (Multiplate Analyzer), von Willebrand factor antigen (VWF:Ag), VWF:ristocetin-cofactor activity (VWF:RCo), activated partial thromboplastin time (aPTT), coagulation factor VIII, fibrinogen, and thrombin generation in adult hospitalized patients with platelet count less than 80 × 10/l...
April 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/29529240/reproducibility-of-teg-parameters-in-stable-cirrhotics
#10
Gemlyn George, Wuttiporn Manatasahit, Manjula Balasubramanian, Victor Navarro
Background: Thromboelastography (TEG) has become the standard of care in liver-transplant surgery to identify real-time abnormalities in the coagulation cascade. To our knowledge, no studies have been performed to measure the intrasubject reproducibility of TEG parameters in cirrhotic patients. Objective: To perform a validation study to determine the reproducibility of TEG in cirrhosis. Methods: We recruited 30 patients with stable cirrhosis and tested 25 of them...
February 24, 2018: Laboratory Medicine
https://www.readbyqxmd.com/read/29528784/wilson-disease-and-lupus-nephritis-is-it-coincidence-or-a-true-association
#11
Saishree Pradhan, Sriram Krishnamurthy, Barath Jagadisan, Nachiappa G Rajesh, Subashini Kaliaperumal, Suryaprakash Ramasamy, Nandeeswari Subramanian
A 12-year-old girl born to third-degree consanguineous parents presented with recurrent episodes of haematuria for 8 months in association with peri-orbital and lower limb oedema for 20 days. There was no jaundice, hepatomegaly or neurological abnormality at presentation. An older brother had died following jaundice at 10 years of age. Urinalysis showed multiple dysmorphic erythrocytes without proteinuria and there was leucopenia, thrombocytopenia and hypo-albuminaemia (23 g/L). C3 component of complementaemia was low and anti-nuclear antibodies and anti-double-stranded DNA antibodies were strongly positive by immunofluorescence...
March 12, 2018: Paediatrics and International Child Health
https://www.readbyqxmd.com/read/29497685/radiofrequency-ablation-rfa-vs-argon-plasma-coagulation-apc-for-the-management-of-gastric-antral-vascular-ectasia-gave-in-patients-with-and-without-cirrhosis-results-from-a-retrospective-analysis-of-a-large-cohort-of-patients-treated-at-a-single-center
#12
Paul St Romain, Amanda Boyd, Jiayin Zheng, Shein-Chung Chow, Rebecca Burbridge, Daniel Wild
Introduction and study aims:  Gastric antral vascular ectasia (GAVE) is a mucosal abnormality associated with multiple conditions, most notably cirrhosis and systemic sclerosis, that causes indolent gastrointestinal bleeding. It is primarily managed with endoscopic therapy. Traditionally, GAVE is endoscopically ablated using argon plasma coagulation (APC) but radiofrequency ablation (RFA) is emerging as an alternative modality. No prior comparison of the 2 modalities has been published...
March 2018: Endoscopy International Open
https://www.readbyqxmd.com/read/29469043/viscoelastic-testing-in-liver-disease
#13
Jessica P E Davis, Patrick G Northup, Stephen H Caldwell, Nicolas M Intagliata
Long thought to be hypocoagulable, new evidence suggests cirrhosis patients have "rebalanced" coagulation in the setting of decreased synthesis of both pro- and anti-coagulant factors. Traditional testing like PT/INR reflects only the decreased synthesis of pro-coagulant factors and thus does not correspond to bleeding or clotting risk in this population. In this review, we discuss the use of viscoelastic testing (VET), an assay of global hemostasis in cirrhosis patients. We describe the technique and interpretation of commercially available VET and assess the application of VET in both transplant and non-transplant cirrhosis populations...
March 1, 2018: Annals of Hepatology
https://www.readbyqxmd.com/read/29468795/suboptimal-use-of-pharmacological-venous-thromboembolism-prophylaxis-in-cirrhotic-patients
#14
Linda S Yang, Sumaya Alukaidey, Katherine Croucher, Damian Dowling
BACKGROUND: Cirrhosis was previously perceived as a haemorrhagic disease state due to frequent associations with coagulopathy and bleeding. However, the coagulopathy of cirrhosis is complex with defects in both pro-coagulant and anticoagulant factors. Derangements in common laboratory indices of coagulation do not accurately reflect bleeding risk or protection from thrombotic events. AIM: We aim to assess the rate of pharmacological prophylaxis for VTE among hospital inpatients with cirrhosis and analyse factors associated with prophylaxis being inappropriately withheld...
February 21, 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29393567/acute-kidney-injury-but-not-sepsis-is-associated-with-higher-procedure-related-bleeding-in-patients-with-decompensated-cirrhosis
#15
Adelina Hung, Guadalupe Garcia-Tsao
BACKGROUND: Bleeding after low-risk invasive procedures can be life-threatening or can lead to further complications in decompensated cirrhosis patients. In unstratified cohorts of hospitalized patients with cirrhosis, the rate of procedure-related bleeding is low despite abnormal coagulation parameters. Our objective was to identify patients with decompensated cirrhosis at a high risk of developing procedure-related bleeding in whom the value of pre-procedure transfusions could be assessed...
February 2, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29361652/proposed-diagnostic-criteria-for-acute-on-chronic-liver-failure-in-japan
#16
Satoshi Mochida, Nobuaki Nakayama, Akio Ido, Kazuaki Inoue, Takuya Genda, Yasuhiro Takikawa, Isao Sakaida, Shuji Terai, Osamu Yokosuka, Masahito Shimizu, Hajime Takikawa
To establish diagnostic criteria for acute-on-chronic liver failure (ACLF) in Japan, the Intractable Hepato-Biliary Disease Study Group of Japan undertook a multicenter pilot survey for patients fulfilling the Asian Pacific Association for the Study of the Liver (APASL), Association for the Study of the Liver-Chronic Liver Failure (EASL-Clif) Consortium, or Chinese Medical Association (CMA) diagnostic criteria for ACLF. The APASL criteria were suitable for screening Japanese patients with ACLF when patients whose conditions were triggered by gastrointestinal bleeding were included within the disease entity, and the EASL-Clif Consortium criteria were useful for classifying the severity of the patients' conditions...
March 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/29333065/hepatitis-c-infection-in-patients-with-hereditary-bleeding-disorders-epidemiology-natural-history-and-management
#17
REVIEW
Nikolaos Papadopoulos, Vasiliki Argiana, Melanie Deutsch
Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prior to 1990, infection with hepatitis C virus (HCV) was mainly transmitted via pooled plasma products as a treatment for hereditary bleeding disorders. Anti-HCV positivity in these patients may be as high as >70% in some areas, while some of them have also been coinfected with human immunodeficiency virus. Since about 20% of HCV-infected patients clear the infection naturally, chronic HCV infection represents a significant health problem in this group of patients...
January 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/29330279/rare-cause-of-isolated-severe-coagulation-failure-in-cirrhosis-traditional-healing-with-fenugreek
#18
Cyriac A Philips, Philip Augustine
Patients with cirrhosis develop decompensation events during the natural history of the disease that encompass ascites, variceal bleeding, hepatic encephalopathy and jaundice. Coagulation failure, defined using the international normalised ratio, even though not a decompensation event, is important in patients with stratifying cirrhosis into those who require liver transplantation for long-term survival. Isolated coagulation failure in cirrhosis is rare and usually occurs with use of anticoagulants in the setting of vascular diseases...
January 12, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29249783/-utility-of-partial-splenic-embolization-prior-to-lung-resection-in-patients-demonstrating-platelet-transfusion-refractoriness-due-to-hypersplenism
#19
Yusuke Tanaka, Isao Matsumoto, Daisuke Saito, Syuhei Yoshida, Seiichi Kakegawa, Masaya Tamura, Hirofumi Takemura
It is often difficult to control perioperative bleeding in patients with liver cirrhosis and concurrent thrombocytopenia and coagulation factor deficiency. Partial splenic embolization (PSE), an auxiliary treatment strategy in management of liver cirrhosis and hepatocellular carcinoma, can not only increase platelets but also improve liver function. With advances in interventional radiology, PSE is a safer and more reliable procedure compared to a splenectomy. We present the case of a 69-year-old man diagnosed with left lung cancer, with thrombocytopenia, and hepatitis C virus-related cirrhosis...
December 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29234191/thromboelastography-for-assessing-the-risk-of-bleeding-in-patients-with-cirrhosis-moving-closer
#20
Vaibhav Somani, Deepak Amarapurkar, Apurva Shah
Background and aims: Conventional coagulation tests (CCTs) in patients with cirrhosis only assess procoagulant factors and are poor predictors of bleeding risk. In spite of this knowledge, they are routinely used prior to invasive procedures, and attempts are made to correct these abnormalities before invasive procedures. These practices are not supported by the evidence and are harmful to the patients. Methods: This prospective study included 150 patients of cirrhosis undergoing invasive procedures...
December 2017: Journal of Clinical and Experimental Hepatology
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