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Cirrhosis anticoagulation

Andrea De Gottardi, Jonel Trebicka, Christoph Klinger, Aurélie Plessier, Susana Seijo, Benedetta Terziroli, Lorenzo Magenta, David Semela, Elisabetta Buscarini, Philippe Langlet, Jan Görtzen, Angela Puente, Beat Müllhaupt, Carmen Navascuès, Filipe Nery, Pierre Deltenre, Fanny Turon, Cornelius Engelmann, Rupen Arya, Karel Caca, Markus Peck-Radosavljevic, Frank W G Leebeek, Dominique Valla, Juan Carlos Garcia-Pagan
BACKGROUND: Direct-acting oral anticoagulants (DOACs) are used in patients with splanchnic vein thrombosis (SVT) and cirrhosis, but evidence for safety and efficacy in this setting is limited. Our aim was to identify indications and reasons for starting or switching to DOACs and to report adverse effects, complications and short-term outcome. METHODS: Data collection including demographic information, laboratory values, treatment and complications through the VALDIG Consortium...
October 25, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Omar D Borjas-Almaguer, Carlos A Cortez-Hernández, Emmanuel I González-Moreno, Francisco J Bosques-Padilla, José A González-González, Aldo A Garza, Juan A Martínez-Segura, Diego García-Compean, Juan V Alejandre-Loya, Jesús García-García, Guillermo Delgado-García, Héctor J Maldonado-Garza
:  Background & Aims. It is unclear whether portal vein thrombosis (PVT) unrelated to malignancy is associated with reduced survival or it is an epiphenomenon of advanced cirrhosis. The objective of this study was to assess clinical outcome in cirrhotic patients with PVT not associated with malignancy and determine its prevalence. MATERIAL AND METHODS: Retrospective search in one center from June 2011 to December 2014. RESULTS: 169 patients, 55 women and 114 men, median age 54 (19-90) years...
November 2016: Annals of Hepatology
Sara R Britnell, Amy E Willets, Adam J Vanderman, Catherine L Woodard, Rachel B Britt
STUDY OBJECTIVE: To describe international normalized ratio (INR) trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis C virus (HCV) with ledipasvir/sofosbuvir with or without ribavirin. DESIGN: Case series. SETTING: Pharmacist-led anticoagulation clinic at a Veterans Affairs medical center. PATIENTS: Four patients aged 59-66 years who were receiving warfarin and had stable, therapeutic INRs and started ledipasvir/sofosbuvir therapy with or without ribavirin for HCV infection...
October 7, 2016: Pharmacotherapy
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
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
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
Naoto Fukunaga, Kenji Uryuhara, Tadaaki Koyama
A 64-year-old female patient with aortitis syndrome presented with progressive intermittent claudication for 6 months. Her medical history was notable for living-donor liver transplantation for primary biliary cirrhosis 4-years prior and chronic immunosuppressive therapy. Evaluation included normal laboratory examination, and contrast-enhanced computed tomography angiography which demonstrated severely calcified descending aorta with high-grade stenosis below the diaphragm. The patient was treated by axillobifemoral bypass using an 8-mm ringed expanded polytetrafluoroethylene graft under general anesthesia...
2016: Annals of Vascular Diseases
Wilma Potze, Mohammad S Siddiqui, Sherry L Boyett, Jelle Adelmeijer, Kalyani Daita, Arun J Sanyal, Ton Lisman
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of thrombosis. However, it remains unclear if hypercoagulability contributes to this risk. We, therefore, determined an in-depth hemostatic profile in a cohort of well-defined patients with NAFLD. METHODS: We drew blood samples from 68 patients with biopsy-proven NAFLD (simple steatosis n=24, NASH n=22, and NASH cirrhosis n=22), 30 lean controls, 30 overweight controls (body mass index (BMI) >25kg/m(2)), and 15 patients with alcoholic (ASH) cirrhosis, and performed in-depth hemostatic profiling...
June 11, 2016: Journal of Hepatology
R Buzelé, L Barbier, A Sauvanet, B Fantin
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever...
August 2016: Journal of Visceral Surgery
Nicoletta Riva, Walter Ageno, Sam Schulman, Jan Beyer-Westendorf, Rita Duce, Alessandra Malato, Rita Santoro, Daniela Poli, Peter Verhamme, Ida Martinelli, Pieter Kamphuisen, Francesco Dentali
BACKGROUND: Little information is available about the clinical history of patients with incidentally detected splanchnic vein thrombosis and its therapeutic management remains controversial. The aim of this study was to assess the risk factors, therapeutic strategies, and long-term outcomes of incidentally detected splanchnic vein thrombosis. METHODS: We analysed data from patients with incidentally detected splanchnic vein thrombosis who were enrolled in an international, multicentre, prospective cohort study of splanchnic vein thrombosis between 2008 and 2012...
June 2016: Lancet Haematology
Hiroshi Fukui, Hidetsugu Saito, Yoshiyuki Ueno, Hirofumi Uto, Katsutoshi Obara, Isao Sakaida, Akitaka Shibuya, Masataka Seike, Sumiko Nagoshi, Makoto Segawa, Hirohito Tsubouchi, Hisataka Moriwaki, Akinobu Kato, Etsuko Hashimoto, Kojiro Michitaka, Toshikazu Murawaki, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa
The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system...
July 2016: Journal of Gastroenterology
Hideya Kamei, Taro Nakamura, Shunji Nagai, Masatoshi Ishigami, Nobuyuki Hamajima
OBJECTIVES: Liver transplant in patients with preexisting portal vein thrombosis involves complicated surgical procedures and increased blood loss, indicating the need for further surgical innovations to overcome these difficulties. Patients who are at high risk of developing portal vein thrombosis may benefit from prophylactic anticoagulant therapy while on the transplant wait list. Homozygosity for C677T polymorphism in the methylenetetrahydrofolate reductase gene has been associated with a high plasma homocysteine concentration, which is a risk factor for venous thrombosis...
June 2016: Experimental and Clinical Transplantation
Héla Baccouche, Asma Labidi, Monia Fekih, Sonia Mahjoub, Houda Kaabi, Slama Hmida, Azza Filali, Neila B Romdhane
Despite the prolongation of coagulation tests, recent studies reported an increased frequency of thromboembolic events in patients with cirrhosis. The aim of this study was to evaluate the haemostatic balance in cirrhotic patients through assessing the variation of pro- and anticoagulant factors and evaluating the in-vitro thrombin generation in patients with cirrhosis and in healthy patients. Fifty-one cirrhotic patients with or without thromboembolic events and 50 controls matched by age and sex were enrolled...
May 13, 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Michael Tischendorf, Wolfgang Miesbach, Umer Chattah, Zenab Chattah, Sebastian Maier, Christoph Welsch, Stefan Zeuzem, Christian M Lange
BACKGROUND: Advanced liver diseases are associated with profound alterations of the coagulation system increasing the risk not only of bleeding, but also of thromboembolic complications. A recent milestone study has shown that prophylactic anticoagulation in liver cirrhosis patients results in a reduced frequency of hepatic decompensation. Yet, INR measurement, one of the most widely applied tests to assess liver function, only inaccurately predicts the risk of hepatic decompensation related to alterations of the coagulation system...
2016: PloS One
Mathieu Pioche, Marine Camus, Jérôme Rivory, Sarah Leblanc, Isabelle Lienhart, Maximilien Barret, Stanislas Chaussade, Jean-Christophe Saurin, Frederic Prat, Thierry Ponchon
BACKGROUND: Endoscopic resections have low morbidity and mortality. Delayed bleeding has been reported in approximately 1 - 15 % of cases, increasing with antiplatelet/anticoagulant therapy or portal hypertension. A self-assembling peptide (SAP) forming a gel could protect the mucosal defect during early healing. This retrospective trial aimed to assess the safety and efficacy of SAP in preventing delayed bleeding after endoscopic resections. METHODS: Consecutive patients with endoscopic resections were enrolled in two tertiary referral centers...
April 2016: Endoscopy International Open
Andrea Mancuso
BACKGROUND: Portal vein thrombosis (PVT) is a complication of cirrhosis. However, whether PVT worsens cirrhosis outcome is a debated issue. AIM: To report an update on the management of PVT. METHODS: A review was performed on the outcome, prevention, and treatment of PVT. RESULTS: Some studies suggest that PVT could worsen the rate of hepatic decompensation and survival of cirrhosis, whereas others report a non-negative impact of PVT in the outcome of cirrhosis...
July 2016: European Journal of Gastroenterology & Hepatology
Francesco Violi, Roberto Gino Corazza, Stephen Hugh Caldwell, Francesco Perticone, Angelo Gatta, Mario Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita Vestri, Valeria Raparelli, Stefania Basili
Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the "Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry" (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up...
March 30, 2016: Internal and Emergency Medicine
Nicolas M Intagliata, Hillary Maitland, Stephen H Caldwell
The risk of thrombosis in patients with chronic liver disease is increasingly recognized. As patients with cirrhosis develop indications for anticoagulation therapy (e.g., venous thromboembolism, portal vein thrombosis, or atrial fibrillation), providers are left to make difficult decisions when selecting therapeutics with little evidence to rely on. Current practice supports the use of low molecular weight heparin or vitamin K antagonists in select patients with cirrhosis requiring anticoagulation. While traditional anticoagulants may be safe and effective in select patients with compensated cirrhosis, the use of direct oral anticoagulants (DOAC) is more controversial...
June 2016: Current Treatment Options in Gastroenterology
Lauren D Nephew, David S Goldberg
No abstract text is available yet for this article.
May 2016: Gastroenterology
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
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