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Hemostasis, Disorders of Coagulation and Transfusion in Cirrhosis

Cyriac Abby Philips, Prasanta Mukhopadhyay.

Abstract
Coagulation disorders in liver diseases, especially cirrhosis occurs due to a complex play between procoagulant and anticoagulant factors. The understanding of bleeding and thrombosis in liver disease is fundamental to management and diagnosis of both these conditions that can occur in liver cirrhosis. In contrast to earlier teaching that considered cirrhosis to be an ‘auto anticoagulated’ state, the current approach to considering it as a state of ‘rebalanced hemostasis’ which can tip to either bleeding profile or thrombotic profile in the same patient has made way to considerable improvements in management and diagnosis of hemostatic and coagulation abnormalities in cirrhosis patients. The liver plays a central role in the four phases of clotting which includes platelet plug initiation and formation, coagulation cascade activity, clotting termination and clot removal by fibrinolysis. Multiple factors such as portal hypertension, decreased thrombopoetin production, endothelial dysfunction and thrombocytopenia and thrombocytopathy in cirrhosis pave way for coagulation abnormalities in this group of patients. Newer modalities like thromboelastography and thrombography have helped in making point of care reliable by improving assessment of coagulation processes globally and further studies and evidence point towards imparting a much better knowledge into this complex situation that is hemostasis/coagulation and liver disease.

Key words: Thrombosis, Bleeding, cirrhosis, hemostasis, thrombocytopenia, TEG


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