Perioperative hemostatic management in the cirrhotic patient: a position paper on the behalf of the Liver Intensive Care Group of Europe (LICAGE).

Perioperative hemostatic management in the cirrhotic patient: a position paper on the behalf of the Liver Intensive Care Group of Europe (LICAGE). Minerva Anestesiol. 2019 Apr 02;: Authors: Biancofiore G, Blasi A, De Boer MT, Franchini M, Hartmann M, Lisman T, Liumbruno GM, Porte R, Saner F, Senzolo M, Werner MJ Abstract Recent data demonstrated that amongst patients undergoing elective surgery the prevalence of cirrhosis is 0.8% equating to approximately 25 million cirrhotic patients undergoing surgery each year worldwide. Overall, the presence of cirrhosis is independently associated with 47% increased risk of postoperative complications and over two and a half increased risk of in-hospital mortality in patients undergoing elective surgery. In particular, perioperative patients with chronic liver disease have long been assumed to have a major bleeding rinsk on the basis of abnormal results for standard tests of hemostasis. However, recent evidence outlined significant changes to traditional knowledge and beliefs and, nowadays, with more sophisticated laboratory tests, it has been shown that patients with chronic liver disease may be in hemostatic balance as a result of concomitant changes in both pro- and antihemostatic pathways. The aim of this paper endorsed by the Liver Intensive Care Group of Europe was to provide an up-to-date overview of coagulation management in periop- erative patients with chronic liver disease focusing on patient blood managem...
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research

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CONCLUSION: Chronic PPI use in cirrhotic patients is associated with significantly higher average West Haven Criteria for HE compared to patients that do not use PPIs. PMID: 31293720 [PubMed]
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
CONCLUSIONS: Our systematic review and meta-analysis did not find any benefits or harms of plasma expanders versus no plasma expander or of one plasma expander such as polygeline, dextrans, hydroxyethyl starch, intravenous infusion of ascitic fluid, crystalloids, or mannitol versus albumin on primary or secondary outcomes. The data originated from few, small, mostly short-term trials at high risks of systematic errors (bias) and high risks of random errors (play of chance). GRADE assessments concluded that the evidence was of very low certainty. Therefore, we can neither demonstrate or discard any benefit of plasma expansi...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSIONS: We found that PVT itself does not lead to a worse prognosis. The most reliable predictor for clinical outcome remains the MELD score. The presence of PVT could be just an epiphenomenon and not a marker of advanced cirrhosis. PMID: 31208663 [PubMed]
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
dquo; Study Group Investigators Abstract BACKGROUND: Current guidelines do not address the post-sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or secondary prophylaxis of variceal bleeding. We hypothesized that in some of these patients portal hypertension drops below the bleeding threshold after sustained virological response, making definitive discontinuation of the betablockers a safe option. AIM: To assess the evolution of portal hypertension, associated factors, non-invasive assessment, and risk ...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Authors: Brigo S, Mancuso E, Pellicano R Abstract The recent changes in terms of both epidemiology of chronic liver disease (CLD) and long-term survival of patients with CLD have had a great impact in the field of dentistry and oral and maxillofacial surgery. In this context, compared with the previous decades, today it is more probable to cure patients with CLD also at advanced stage (cirrhosis), that could remain asymptomatic for long, before the appearance of signs of decompensation. Hence, it is crucial to identify the patient with CLD and to define the stage of the latter. The main risks are the viral acquisit...
Source: Minerva Stomatologica - Category: Dentistry Tags: Minerva Stomatol Source Type: research
Publication date: Available online 28 April 2019Source: Journal of Clinical and Experimental HepatologyAuthor(s): Atul Gawande, Gaurav K. Gupta, Ankit Gupta, Shashank J. Wanjari, Vasudha Goel, Vinay Rathore, Hemendra Bhardwaj, Sandeep NijhawanBackground and AimsThe present study is planned to assess etiologies, course, and outcome in patients with acute-on-chronic liver failure (ACLF).MethodsTwo hundred and eight (182 males and 26 females) patients of ACLF fulfilling modified Asia Pacific Association For Study Of Liver Consensus criteria 2009 admitted to the gastroenterology department of SMS Medical College and hospital, ...
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
Authors: Yerke J, Bauer SR, Bass S, Torbic H, Militello M, Roach E, Hanouneh I, Welch S Abstract BACKGROUND: Patients with liver disease are concomitantly at increased risk of venous thromboembolism (VTE) and bleeding events due to changes in the balance of pro- and anti-hemostatic substances. As such, recommendations for the use of pharmacological VTE prophylaxis are lacking. Recent studies have found no difference in rates of VTE in those receiving and not receiving pharmacological VTE prophylaxis, though most studies have been small. Thus, our study sought to establish if pharmacological VTE prophylaxis is effec...
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Rationale: In living-donor liver transplantation (LDLT), the right lobe graft is commonly utilized to prevent small-for-size syndrome, despite the considerable donor morbidity. Conversely, the feasibility of the left lobe graft and the right posterior section graft in smaller-sized recipients is now commonly employed with comparable outcomes to right lobe grafts. The efficacy of the right anterior section graft has rarely been reported. Patient concerns: A 56-year-old man, a heavy alcoholic beverage drinker for 20 years, presented in the emergency department with massive ascites and lethargy. He was previously admitte...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion Massive SI and immune cell paralysis associated with ACLF represent the extreme severity of CAID in response to an infectious or sterile challenge. The severe immune disturbance plays a pivotal role in the pathogenesis of the distinctive features of ACLF: organ failure and bacterial infection susceptibility. Excessive SI in ACLF results from the massive activation and dysfunction of an innate immune system challenged by increased PAMPs and DAMPs. SI leads to cell and tissue immunopathology contributing to hepatic and extrahepatic organ failure. Concomitantly, the course of ACLF is associated with a disproportio...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
We present the case of a patient with diabetes showing minimal perturbations of liver function tests, but for whom a simple blood fibrosis test suggested the presence of advanced liver fibrosis. The patient was referred to a hepatologist who confirmed the diagnosis using a specialized blood test and transient elastography. Thereafter, a liver biopsy was performed and pathology was positive for cirrhosis. An upper gastrointestinal endoscopy showed no gastrointestinal varices. Simple blood fibrosis tests are very attractive for the first-line evaluation of liver fibrosis by non-specialists in the large populations of NAFLD a...
Source: Clinics and Research in Hepatology and Gastroenterology - Category: Gastroenterology Source Type: research
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