Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most?

Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most? World J Hepatol. 2015 Jul 18;7(14):1818-27 Authors: Rodríguez-Castro KI, Antonello A, Ferrarese A Abstract The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being "auto-anticoagulated", prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications. Although many clinical decisions are still based on traditional coagulation parameters such as prothrombin (PT), PT, and international normalized ratio, it is increasingly recognized that these tests do not adequately predict the risk of bleeding, nor they should guide pre-emptive interventions. Moreover, altered coagulation tests should not be considered as a contraindication to the use of anticoagulation, although this therapeutic or prophylactic approach is not at present routinely undertaken. Gastroesophageal variceal bleeding continues to be one of the most feared and deadly complications of cirrhosis and portal hypertension, but great progresses have been made in preve...
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research