Coagulation and hemostasis in liver disease : controversies and advances

✍ Scribed by Stephen H. Caldwell; Arun J. Sanyal

• Publisher: Saunders
• Year: 2009
• Tongue: English
• Leaves: 151
• Series: Clinics in liver disease
• Category: Library

✦ Table of Contents

Cover
Preface
The Coagulation Cascade in Cirrhosis
Step 1: initiation of coagulation on tissue factor-bearing cells
Step 2: amplification of the procoagulant signal by thrombin generated on the tissue factor-bearing cell
Step 3: propagation of thrombin generation on the platelet surface
The critical role of plasma protease inhibitors
The protein C/S/thrombomodulin system provides protection from thrombosis
What happens to the coagulation system in liver disease?
Summary
References
The Platelet and Platelet Function Testing in Liver Disease
Platelet adhesion and activation under conditions of flow
Platelets in liver disease
Bleeding time and platelet aggregation: diagnostic tools for bleeding risk?
The relevance of thrombocytopenia and reduced platelet function in cirrhosis
Summary
References
Hyperfibrinolysis in Liver Disease
Pathophysiology of hyperfibrinolysis in liver disease
Imbalance of the Fibrinolytic System
Accelerated Intravascular Coagulation and Fibrinolysis
Hyperfibrinolysis and bleeding
Hyperfibrinolysis in liver transplantation
Therapy
Summary
References
Superimposed Coagulopathic Conditions in Cirrhosis: Infection and Endogenous Heparinoids, Renal Failure, and Endothelial Dysfunction
Infection and endogenous heparinoids
Renal failure coagulopathy in cirrhosis
Endothelial function in cirrhosis
Summary
References
Heparin-like Effect in Liver Disease and Liver Transplantation
Infection, coagulation, and heparin-like effect
Heparin-like Effect and Liver Transplant
The effect of glycosaminoglycans on coagulation and their activity in liver disease and liver transplant
Therapeutic Implications
Summary
References
Tests of Coagulation in Liver Disease
Coagulation
Prothrombin Time
Activated Partial Thromboplastin Time
Clinical Value of Prothrombin Time and Activated Partial Thromboplastin Time in Cirrhosis
Thrombin Generation Test
The Prothrombin Time as an Index of Prognosis in Cirrhosis
Fibrinolysis
Thromboelastography
Summary
References
The International Normalized Ratio of Prothrombin Time in the Model for End-Stage Liver Disease Score: A Reliable Measure
Generic causes of variation in the international normalized ratio
Liver-specific causes of variation in the international normalized ratio
The Model for End-stage Liver Disease as a predictor of survival
Summary
References
International Normalized Ratio ofnbspProthrombin Time innbspthe Model for End-stage Liver DiseasenbspScore: An Unreliable Measure
Model for End-stage Liver Disease determinants
Limitations of the international normalized ratio
The international normalized ratio in liver disease
The ‘‘international normalized ratio problem’’
Perspective
Summary
References
Blood Products, Volume Control, and Renal Support in the Coagulopathy of Liver Disease
Plasma transfusion as treatment of coagulopathy
Transfusion-related lung injury
Platelets and packed red blood cells
Volume expansion, portal hypertension, and bleeding diathesis in cirrhosis
Effects on Portal Pressure
Other Agents
Coagulopathy and renal failure in patients who have cirrhosis
Uremic Platelet Dysfunction
Dialysis Catheter Placement
Renal Replacement Therapy
Volume contraction therapy
Summary
References
The Role of Anti-Fibrinolytics, rFVIIa and Other Pro-Coagulants: Prophylactic Versus Rescue?
Recombinant activated factor VIIa
Antifibrinolytic drugs
Therapeutic versus prophylactic therapy with pro-coagulants
Summary
References
Coagulopathy of Acute Liver Failure
Frequency and severity
Pathophysiology
Clinical presentation
Spontaneous Bleeding
Iatrogenic Bleeding
Bleeding During and After Orthotopic Liver Transplantation (OLT)
Laboratory evaluation
Management
Summary
References
Hypercoagulation in Liver Disease
Liver disease and the coagulation system
Consequences of Hypercoagulation in Cirrhosis
Macrovascular thrombotic disease
Microvascular thrombotic disease
Summary
References
Parenchymal Extinction: Coagulation and Hepatic Fibrogenesis
A role for clotting in hepatic fibrogenesis
Microthrombi and Hepatic Damage in Animal Models
Epidemiologic and Clinical Evidence
Pathogenic mechanisms
Parenchymal Extinction: Intrahepatic Microthrombi Causing Tissue Ischemia and Fibrosis
Direct Stellate Cell Activation: Thrombin-Mediated Hepatic Stellate Cell Activation by Protease Activated Receptors-1
Potential therapeutic implications
Therapeutic Studies in Animal Models
Therapeutic Effects in Humans
Summary
References
Portal Vein Thrombosis and Budd-Chiari Syndrome
Risk factors for portal vein thrombosis and Budd-Chiari syndrome
Evaluation of thrombophilia, portal vein thrombosis, and Budd-Chiari syndrome
Portal vein thrombosis
Extrahepatic Portal Vein Obstruction in Childhood
Nonmalignant, Noncirrhotic Extrahepatic Portal Vein Obstruction in Adults
Portal Vein Thrombosis in Chronic Liver Disease
Budd-Chiari syndrome
Association of Budd-Chiari syndrome, extrahepatic portal vein obstruction, and noncirrhotic portal hypertension
Summary
References
Bleeding in Liver Surgery: Prevention and Treatment
Surgical strategies to reduce blood loss
Anesthesiologic strategies to reduce blood loss
Pharmacologic strategies to reduce blood loss
Topical Hemostatic Agents
Antifibrinolytics
Procoagulant Drugs
Summary
References
Coagulation Disorders and Bleeding in Liver Disease: Future Directions
Bleeding risk assessment
Blood product and procoagulant use in cirrhosis
Implementation of the international normalized ratioliver?
Progression of cirrhosis due to parenchymal extinction
Summary
References