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Coagulation in cirrhosis

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...
October 14, 2016: European Journal of Gastroenterology & Hepatology
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: Visc Med
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
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
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...
September 2, 2016: Journal of Oral and Maxillofacial Surgery
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
Robert J Huang, Ryan B Perumpail, Nirav Thosani, Ramsey Cheung, Shai Friedland
BACKGROUND AND STUDY AIMS: Cirrhotic patients are at a theoretically increased risk of bleeding. The safety of polypectomy in cirrhosis is poorly defined. PATIENTS AND METHODS: We performed a retrospective review of patients with cirrhosis who underwent colonoscopic polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were collected. Development of complications including immediate bleeding, delayed bleeding, hospitalization, blood transfusion, perforation, and death were recorded to 30-day follow-up...
September 2016: Endoscopy International Open
E E Starostina, L M Samokhodskaya, T P Rozina, T N Krasnova, E B Yarovaya, N A Mukhin
AIM: to estimate the clinical and prognostic value of the carriage of different allele variants of the gene polymorphisms of the coagulation system and platelet receptors in the progression of liver fibrosis (LF) in patient with chronic hepatitis C (CHC). SUBJECTS AND METHODS: The investigation enrolled 177 patients with CHC and liver cirrhosis at its outcome who were divided into 2 groups according to the rate of LF progression: 1) 89 patients with rapid (rapid fibrosis) and 2) 88 patients with slow (slow fibrosis) progression...
2016: Terapevticheskiĭ Arkhiv
Sotiria Bedreli, Jan-Peter Sowa, Saraa Malek, Sandra Blomeyer, Antonios Katsounas, Guido Gerken, Fuat H Saner, Ali Canbay
BACKGROUND & AIMS: Patients with progressive liver disease exhibit complex coagulation disorders. Factor XIII plays a crucial role in the last steps of haemostasis, and its deficiency is associated with an increased incidence of bleeding diathesis. However, current conventional coagulation tests cannot detect factor XIII deficiency. In this study, we examined factor XIII activity and the ability of rotational thromboelastometry to detect factor XIII deficiency and bleeding diathesis in patients with cirrhosis...
September 16, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
N Esteve, A Ferrer, C Sansaloni, M Mariscal, M Torres, C Mora
OBJECTIVES: Perioperative epidural analgesia in liver resection provides optimal dynamic pain relief. Coagulation disorders occurring in the postoperative period can lead to greater risk of complications during epidural catheter removal. The aim of this study is to evaluate the effectiveness and complications of epidural analgesia and delayed epidural catheter removal due to postoperative coagulopathy. METHODS: A retrospective study of 114 patients undergoing open liver resection and epidural analgesia, from March 2012 to February 2015...
August 20, 2016: Revista Española de Anestesiología y Reanimación
Sabrina Bimonte, Maddalena Leongito, Mauro Piccirillo, Cristina de Angelis, Claudia Pivonello, Vincenza Granata, Francesco Izzo
Hepatocellular carcinoma (HCC) is the fifth most frequent cancer worldwide with high morbidity, mortality and increasing incidence. It is of note that the main curative therapies for HCC are hepatic resection and transplantation although the majority of patients at the time of presentation are not eligible for resection or orthotopic liver transplantation (OLT) due to the underlying cirrhosis. Currently, a variety of loco-regional therapies, including radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), microwave coagulation therapy (MCT), transarterial chemoembolization (TACE) and others, have been developed as alternative treatment options for HCC...
2016: Infectious Agents and Cancer
Ko Watanabe, Takuto Hikichi, Jun Nakamura, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Yuichi Waragai, Hitomi Kikuchi, Naoki Konno, Hiroyuki Asama, Mika Takasumi, Hiroshi Watanabe, Katsutoshi Obara, Hiromasa Ohira
A 58-year-old man with liver cirrhosis and renal failure was diagnosed with esophageal varices (EVs) and a gastric cardia varix (GCV) by esophagogastroduodenoscopy (EGD). The patient also exhibited early gastric cancer (EGC) in the upper gastric body adjacent to the GCV. The EVs and GCV were treated using endoscopy before endoscopic submucosal dissection (ESD) of the EGC to prevent variceal bleeding during ESD. Endoscopic variceal ligation (EVL) was performed to treat the EVs. In addition, extra-variceal polidocanol injection and argon plasma coagulation (APC) were performed after EVL...
July 30, 2016: Fukushima Journal of Medical Science
Armando Tripodi, Massimo Primignani, Simon Braham, Veena Chantarangkul, Marigrazia Clerici, Marco Moia, Flora Peyvandi
BACKGROUND/AIMS: Information on coagulation for cirrhotics on anticoagulants is scanty. We investigated plasma from 23 cirrhotics treated with low-molecular-weight-heparin (LMWH) followed by vitamin K antagonists (VKA). METHODS: On days 1-4 patients received full-dose LMWH. On day-5 VKA was started and LMWH was terminated when INR therapeutic-interval was reached. Blood was collected at peak and trough during LMWH, LMWH+VKA and VKA. Non-cirrhotics on VKA were included as controls...
October 2016: Digestive and Liver Disease
Lisa Baumann, Susanne Haen, Christoph Berg, Ferruh Artunc, Reimer Riessen, Werner Spengler, Falko Fend, Michael Haap
HISTORY AND ADMISSION FINDINGS: We report on a 48-year-old man presenting with progressive hepatopathy and encephalopathy for two weeks based on a chronic hepatitis C. He takes ledipasvir and sofosbuvir (Harvoni) and ribavirin for almost 24 weeks. After admission to hospital his state deteriorated rapidly. He is directly transferred to the medical intensive care unit, where he died on day 3. INVESTIGATIONS: During the physical examination, a pronounced jaundice and significant peripheral edema were found...
July 2016: Deutsche Medizinische Wochenschrift
Aurelien Lebreton, Thomas Sinegre, Bruno Pereira, Géraldine Lamblin, Cédric Duron, Armando Abergel
BACKGROUND & AIMS: Cirrhosis significantly changes all hemostasis steps. Recent studies suggest that cirrhosis is associated with a coagulopathy leading to a hypercoagulable state. The underlying mechanisms are not fully understood, but protein C deficiency is probably a major determinant of this phenotype. The aim of this study was to compare the results of thrombin generation assays performed with addition thrombomodulin or activated protein C to assess the effect of by-passing the protein C activation step in cirrhotic patients and healthy controls...
July 15, 2016: Journal of Gastroenterology and Hepatology
Karl Egan, Audrey Dillon, Eimear Dunne, Barry Kevane, Zita Galvin, Patricia Maguire, Dermot Kenny, Stephen Stewart, Fionnuala Ni Ainle
Cirrhosis is a consequence of prolonged liver injury and is characterised by extensive tissue fibrosis: the deposition of collagen-rich extracellular matrix. The haemostatic balance is disordered in cirrhosis and coagulation activation appears to promote fibrosis. In spite of recent studies demonstrating a role for anticoagulant therapy in preventing cirrhosis progression, there has not been a change in clinical practice, suggesting that physicians are reluctant to anticoagulate patients with cirrhosis due to bleeding risks...
July 14, 2016: Journal of Thrombosis and Thrombolysis
Mohammed Elhendawy, Samah Mosaad, Walaa Alkhalawany, Lobna Abo-Ali, Mohamed Enaba, Aymen Elsaka, Asem A Elfert
BACKGROUND: Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent hemorrhage and thus, chronic anemia, in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method, but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective randomized controlled study was to evaluate the safety and efficacy of EBL, as compared to APC, in the treatment of GAVE and gastric fundal vascular ectasia (GFVE)...
June 2016: United European Gastroenterology Journal
Oana Sîrbu, Mariana Floria, Petru Dăscălița, Victorița Şorodoc, Laurențiu Şorodoc
Non-alcoholic fatty liver disease (NAFLD) includes a range of disorders characterized by excess accumulation of triglycerides within the liver. While simple steatosis may be clinically stable, non-alcoholic steatohepatitis (NASH) can be progressive. Inflammation is believed to be the driving force behind NASH and the progression to fibrosis and subsequent cirrhosis. NAFLD is globally considered a significant health concern not only because of its incidence but also because of its economic impact. The fact that NAFLD is associated with cardiovascular disease is widely recognized, as well as the fact that NAFLD patient mortality rises when such an association is present...
July 2016: Anatolian Journal of Cardiology
Stuart Cleland, Carlos Corredor, Jia Jia Ye, Coimbatore Srinivas, Stuart A McCluskey
From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials...
June 24, 2016: World Journal of Transplantation
Seong Ran Jeon, Jeong-Sik Byeon, Hyun Joo Jang, Soo Jung Park, Jong Pil Im, Eun Ran Kim, Ja Seol Koo, Bong Min Ko, Dong Kyung Chang, Jin-Oh Kim, Su Yeon Park
BACKGROUND/AIMS: Angioectasias are the most common sources of bleeding in the small bowel. They can be treated using balloon-assisted enteroscopy (BAE). This study aimed to identify the rebleeding rate and associated factors after BAE in patients with small bowel angioectasia bleeding. METHODS: We retrospectively analyzed the records of patients with bleeding due to small bowel vascular lesion in a multicenter enteroscopy database including 1,108 BAEs. Finally, in rebleeding analysis, we analyzed 66 patients with angioectasia on the basis of the Yano-Yamamoto classification...
June 29, 2016: Journal of Gastroenterology and Hepatology
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