Publication

Is there a rationale for treatment of chronic liver disease with antithrombotic therapy?

Hugenholtz, G. C. G., Northup, P. G., Porte, R. J. & Lisman, T., Mar-2015, In : Blood reviews. 29, 2, p. 127-136 10 p.

Research output: Contribution to journalReview articleAcademicpeer-review

Recent advances in the understanding of the coagulopathy in chronic liver disease have provided a strong support for anticoagulation as a new therapeutic paradigm for patients with cirrhosis. Laboratory studies indicate that the net effect of changes in hemostasis in many patients with chronic liver disease is a hypercoagulable status. In turn, clinical thrombosis is increasingly recognized as a complication of liver disease. When occurring within the liver, thrombosis may even progress the disease course. Exciting preliminary data regarding the potential of low-molecular-weight heparin to slow down the progression of liver disease indicate that this class of drugs may improve outcome without a major increase in bleeding risk. However, this new era for antithrombotic therapy in chronic liver disease is still hindered by a persistent false notion that patients with cirrhosis are "auto-anticoagulated" by their underlying liver disease. In addition, there is insufficient clinical evidence on safety and efficacy of anticoagulant therapy in cirrhosis and the studies conducted so far are limited by small sample sizes, uncontrolled treatment arms, or by their retrospective nature. Finally, a lack of knowledge on how or when to monitor antithrombotic treatment to optimize the risk-benefit ratio has restricted a widespread application of anticoagulant treatment in clinical management algorithms. Nonetheless, by systematically covering possibilities and pitfalls, this review highlights the potential of antithrombotic therapy to improve the quality of life and the clinical outcome of patients with chronic liver disease. (C) 2014 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)127-136
Number of pages10
JournalBlood reviews
Volume29
Issue number2
Publication statusPublished - Mar-2015

    Keywords

  • Chronic liver disease, Cirrhosis, Hemostasis, Thrombosis, Anticoagulation, NONALCOHOLIC FATTY LIVER, MOLECULAR-WEIGHT HEPARIN, PORTAL-VEIN THROMBOSIS, PLASMINOGEN-ACTIVATOR INHIBITOR, CHRONIC HEPATITIS-C, HOSPITALIZED CIRRHOSIS PATIENTS, TYPE-2 DIABETIC-PATIENTS, CORONARY-ARTERY-DISEASE, RECOMBINANT FACTOR VIIA, FACTOR-V-LEIDEN

ID: 20100724