肝硬化患者的止血改变和止血管理

StephenW

肝硬化患者的止血改变和止血管理

    顿利斯曼
    斯蒂芬·H·考德威尔
    尼古拉斯·M·英塔利亚塔

开放存取DOI：https://doi.org/10.1016/j.jhep.2021.11.004

    概括
    关键词
    介绍
    出血的发病机制
    预防出血
    出血的治疗
    血栓形成的发病机制
    预防血栓形成
    血栓形成的治疗
    结论
    经济支持
    作者的贡献
    利益冲突
    补充数据
    参考
    文章信息
    数据
    表
    相关文章

概括
肝硬化患者的止血系统经常出现复杂的变化，包括血小板计数减少和各种止血蛋白水平降低。尽管历史上肝硬化患者被认为具有与止血相关的出血倾向，但现在人们普遍认为，由于促止血系统和抗止血系统同时发生变化，肝硬化患者的止血系统保持平衡。再平衡止血的概念导致了临床管理的变化，尽管在很大程度上缺乏来自精心设计的临床研究的确凿证据。例如，肝硬化患者和凝血酶原时间延长的许多侵入性手术现在在没有预防的情况下使用新鲜冷冻血浆进行。相反，临床医生已经更加意识到抗血栓治疗的必要性，即使在那些常规凝血测试异常的患者中也是如此。本文将概述肝硬化患者出血和血栓并发症的发病机制、预防和治疗的最新进展。除其他主题外，我们将讨论急性肝硬化患者的止血状态、肝硬化患者出血的各种原因，以及如何最好地预防或治疗出血。此外，我们将讨论肝硬化患者的高凝特征、对门静脉血栓形成发病机制的新见解，以及如何最好地预防或治疗血栓形成。
关键词

    肝病
    血栓形成
    流血的
    门静脉血栓形成
    静脉曲张出血
    血小板
    凝血
    新鲜冷冻血浆

StephenW

Haemostatic alterations and management of haemostasis in patients with cirrhosis

    Ton Lisman
    Stephen H. Caldwell
    Nicolas M. Intagliata

Open AccessDOI:https://doi.org/10.1016/j.jhep.2021.11.004

    Summary
    Keywords
    Introduction
    Pathogenesis of bleeding
    Prevention of bleeding
    Treatment of bleeding
    Pathogenesis of thrombosis
    Prevention of thrombosis
    Treatment of thrombosis
    Conclusion
    Financial support
    Authors’ contributions
    Conflict of interest
    Supplementary data
    References
    Article Info
    Figures
    Tables
    Related Articles

Summary
Patients with cirrhosis frequently acquire complex changes in their haemostatic system including a decreased platelet count and decreased levels of various haemostatic proteins. Although historically patients with cirrhosis were thought to have a haemostasis-related bleeding tendency, it is now widely accepted that the haemostatic system of patients with cirrhosis remains in balance as a result of simultaneous changes in pro- and anti-haemostatic systems. The concept of rebalanced haemostasis has led to changes in clinical management, although firm evidence from well-designed clinical studies is largely lacking. For example, many invasive procedures in patients with cirrhosis and a prolonged prothrombin time are now performed without prophylaxis with fresh frozen plasma. Conversely, clinicians have become more aware of the need for anti-thrombotic therapy, even in those patients with abnormal routine coagulation tests. This paper will outline recent advances in pathogenesis, prevention and treatment of both bleeding and thrombotic complications in patients with cirrhosis. Among other topics, we will discuss the haemostatic status of acutely ill patients with cirrhosis, the various causes of bleeding in patients with cirrhosis, and how best to prevent or treat bleeding. In addition, we will discuss the hypercoagulable features of patients with cirrhosis, new insights into the pathogenesis of portal vein thrombosis, and how best to prevent or treat thromboses.
Keywords

    liver disease
    thrombosis
    bleeding
    portal vein thrombosis
    variceal bleeding
    platelets
    coagulation
    fresh frozen plasma

StephenW

http://www.journal-of-hepatology.eu/article/S0168827821021723/pdf