Hematological Issues in Liver Disease

• Published in: Critical care clinics Vol. 32; no. 3; p. 385
• Main Authors: Allison, Michael G, Shanholtz, Carl B, Sachdeva, Ashutosh
• Format: Journal Article
• Language: English
• Published: United States 01.07.2016
• Subjects: Anticoagulants - therapeutic use; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - etiology; Disseminated Intravascular Coagulation - etiology; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - physiopathology; Liver Failure, Acute - complications; Liver Failure, Acute - physiopathology; Thrombosis - etiology; Thrombosis - prevention & control; Thrombosis - therapy; Thrombocytopenia; Acute liver failure; Cirrhosis; Anticoagulation; Thrombosis; Coagulopathy
• ISSN: 1557-8232
• DOI: 10.1016/j.ccc.2016.03.004

Acute and chronic liver failure are associated with numerous alterations in different features of the coagulation system. Consequently, there is widespread confusion regarding the potential for both bleeding and thrombosis in patients with liver disease. The risk of bleeding is related to the hemodynamic changes in portal pressures and venous congestion whereas the thrombotic risk stems from changes in the coagulation system. Antithrombotic prophylaxis and treatment of patients with hemorrhage and thrombosis requires careful assessment, interpretation of laboratory workup, and attention to coexistent morbidities. A framework for the management of these conditions is presented for clinicians.