SHM's Clinical Quick Talks-Coagulopathy and Thrombocytopenia in Patients with Cirrhosis

Pdf Summary

Coagulopathy and thrombocytopenia are prominent concerns in patients with cirrhosis, significantly affecting their hemostatic profile. Despite an increased bleeding risk, traditional laboratory markers like platelet count, PT, INR, and PTT are insufficient in predicting these risks. Patients with cirrhosis face a dual threat: a potential for bleeding due to factors such as impaired synthesis of clotting factors, platelet dysfunction, and variceal bleeding linked to portal hypertension, alongside a heightened risk of thrombosis. The latter condition is influenced by factors including reduced production of anticoagulant proteins and increased von Willebrand factor, contributing to issues like portal and peripheral deep vein thrombosis.<br /><br />Thrombocytopenia, prevalent in up to 75% of cirrhosis cases, is caused by decreased platelet production, increased clearance, and splenic sequestration. The liver's compromised ability to produce thrombopoietin results in reduced bone marrow production of platelets. Additional contributors to thrombocytopenia include alcohol use, hepatitis B and C infections, and certain medications, which can suppress bone marrow function. Furthermore, portal hypertension leads to splenomegaly, exacerbating platelet sequestration, while low-grade endotoxemia may impair platelet functionality.<br /><br />Cirrhotic patients exist in an unpredictable balance between hypocoagulability and hypercoagulability. Non-traditional factors intrinsic to the disease, such as high portal pressures, variceal development, and venous stasis, play significant roles in their coagulopathic profile. Understanding these dynamics is crucial for evaluating and managing the coagulopathy and thrombocytopenia in cirrhosis. <br /><br />The article underscores the complexity and dual nature of hemostatic imbalances in cirrhotic patients and highlights the need for more nuanced approaches to predicting and managing bleeding and clotting risks in this population.

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Cynthia Nguyen, Ian Gleaner

Keywords

coagulopathy

thrombocytopenia

cirrhosis

hemostatic profile

bleeding risk

thrombosis

portal hypertension

platelet dysfunction

anticoagulant proteins

variceal bleeding