Coagulation Abnormalities in Liver Cirrhosis: Diagnostic and Therapeutic Approaches

TL;DR

This paper reviews how liver cirrhosis disrupts blood clotting and discusses diagnostic and treatment approaches for related complications.

Contribution

The paper provides a systematic review of coagulation abnormalities in liver cirrhosis and highlights viscoelastic testing as a promising diagnostic method.

Findings

Liver cirrhosis causes both bleeding and clotting risks due to disrupted coagulation.

Viscoelastic testing is suggested as the most appropriate method for diagnosing coagulopathies in cirrhosis.

The paper outlines treatment strategies for managing bleeding and thrombotic complications in cirrhotic patients.

Abstract

The liver is the primary site of synthesis for most coagulation factors and the central organ responsible for maintaining hemostatic equilibrium. In individuals with advanced liver disease, significant disruptions in coagulation homeostasis occur and consequently predispose patients to both thrombotic and bleeding complications. This review summarizes the pathophysiologic basics of liver cirrhosis-associated coagulopathies and discusses the diagnosis and treatment of common procoagulant conditions such as portal vein thrombosis and post-transplant hepatic artery thrombosis. The review also systematically addresses the most common bleeding complications, including spontaneous, portal hypertension-related, and periprocedural bleeding. The proper pre-procedural assessment of the bleeding risk is often required due to the great number of invasive procedures to which these patients are frequently subjected. The viscoelastic testing (thromboelastogram and thromboelastometry) seems to emerge as the most appropriate diagnostic method. Specific treatment recommendations for the correction of coagulation abnormalities and the management of severe thrombocytopenia are hereby presented.

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