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The coagulopathy of chronic liver disease: Is there a causal relationship with bleeding? No

2010; Elsevier BV; Volume: 21; Issue: 2 Linguagem: Inglês

10.1016/j.ejim.2010.02.001

1879-0828

Armando Tripodi,

Liver Disease and Transplantation

The integrity of the vascular system in normal conditions is secured by highly integrated cellular and humoral processes that include primary hemostasis (platelet–vessel wall interaction), coagulation (thrombin generation and fibrinogen-to-fibrin conversion) and fibrinolysis (fibrin-clot dissolution). Impairment in anyone of these processes may result in bleeding or thrombosis. Chronic liver diseases are associated with thrombocytopenia and/or thrombocytopathy, decreased synthesis of most coagulation factors and hyper-fibrinolysis. Because of the above characteristics chronic liver disease has been identified until recently as the prototype of the acquired hemostasis abnormalities and the causal relationship between abnormal hemostasis tests and the risk of bleeding has become a paradigm. In this Debate I shall attempt to demonstrate how data from the most recent literature challenge this dogma. This reassessment may have important practical implications for treatment and prophylaxis of patients with chronic liver disease.