Bleeding Risk and Management in Interventional Procedures in Chronic Liver Disease

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• 作者：Gia A. DeAngelis ; MD^a ; ^{gad9a@virginia.edu" class="auth_mail" title="E-mail the corresponding author} ; Rachita Khot ; MD^a ; Ziv J Haskal ; MD^a ; Hillary S. Maitland ; MD^b ; Patrick G. Northup ; MD^c ; Neeral L. Shah ; MD^c ; Stephen H. Caldwell ; MD^c
• 关键词：AASLD ; Association for the Study of Liver Disease ; ACLF ; acute-on-chronic liver failure ; AICF ; accelerated intravascular coagulation and fibrinolysis ; ALF ; acute liver failure ; aPTT ; activated partial thromboplastin time ; CLD ; chronic liver disease ; DDAVP ; desmopressin acetate ; DIC ; disseminated intravascular coagulation ; FFP ; fresh frozen plasma ; HVPG ; hepatic venous pressure gradient ; INR ; international normalized ratio ; rFVIIa ; recombinant factor VIIa ; TF ; tissue factor ; vWF ; von Willebrand f
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：27
• 期：11
• 页码：1665-1674
• 全文大小：731 K

文摘

The coagulopathy of liver disease is distinctly different from therapeutic anticoagulation in a patient. Despite stable elevated standard clot-based coagulation assays, nearly all patients with stable chronic liver disease (CLD) have normal or increased clotting. Common unfamiliarity with the limitations of these assays in CLD may lead to inappropriate and sometimes harmful interventions, including blood product transfusions before a procedure. Knowledge of the distinct hemostatic alterations in CLD can allow identification of the small subset of patients with clinically significant coagulopathy who can benefit from hematologic optimization before invasive procedures.