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Semin Thromb Hemost 2020; 46(06): 656-664
DOI: 10.1055/s-0040-1714205
Review Article

Incidence of Bleeding and Thrombosis in Patients with Liver Disease

Lara N. Roberts
1   Department of Haematological Medicine, King's Thrombosis Centre, London, United Kingdom
,
William Bernal
2   Liver Intensive Therapy Unit, Institute of Liver Studies, King’s College Hospital, London, United Kingdom
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Abstract

Historically, liver disease has been associated with a bleeding tendency. Global hemostatic assays have demonstrated that hemostasis is overall rebalanced, in both acute liver failure and chronic liver disease. It is now recognized that many bleeding events in chronic liver disease are mediated by portal hypertension rather than an underlying hemostatic defect. This is acknowledged in recent guidelines, which recommend against coagulation testing prior to low risk procedures in this patient group, with avoidance also of attempts at correction of prolonged coagulation times. Over time, the incidence of bleeding events has decreased in both chronic liver disease and acute liver failure, with improved supportive care, targeted treatments for underlying cause of liver disease, and the advent of liver transplantation. Concurrently, there has been increased recognition of the risk of thrombosis in chronic liver disease, with a predilection for the splanchnic vasculature. This review describes the incidence of bleeding and thrombosis in chronic liver disease and acute liver failure, including the periprocedural and liver transplantation setting.

Keywords

cirrhosis - acute liver failure - hemorrhage - thrombosis - incidence


Publication History

Article published online:
05 August 2020

© 2020. Thieme. All rights reserved.

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