In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

Liver International : Official Journal of the International Association for the Study of the Liver
Ton LismanWilliam Bernal

Abstract

A simultaneous decline in pro- and anticoagulant drivers in patients with liver diseases results in a "rebalanced" haemostatic system, even in acutely ill patients. Nevertheless, both bleeding and thrombotic events are common. Here, we explored efficacy of pro- and antihaemostatic strategies in compensated and acutely ill cirrhotics which may be unpredictable given the profound haemostatic changes. We tested the effects in vitro of the addition of clinically relevant doses of commonly used pro- and antihaemostatic strategies in plasma from healthy individuals (n = 30) and patients with compensated (n = 18) and acutely decompensated cirrhosis (n = 18), and acute-on-chronic liver failure (n = 10). We used thrombin generation tests and fibrin clot permeability assays to assess potency of various approaches. Fresh frozen plasma and recombinant factor VIIa modestly increased thrombin generation (10%-20%). Prothrombin complex concentrate increased thrombin generation two-fold in controls and 2-4-fold in patients. Clot permeability decreased after addition of fibrinogen concentrate by 51% in controls and by 50%-60% in patients. Low molecular weight heparin decreased thrombin generation by 18% in controls and by 23%-54% in patients. Si...Continue Reading

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Citations

Aug 2, 2018·Hepatology International·R Todd Stravitz
Mar 7, 2020·Current Opinion in Gastroenterology·Matthew J StottsNeeral L Shah
Aug 21, 2020·Seminars in Thrombosis and Hemostasis·Aurélien LebretonTon Lisman
Aug 21, 2020·Seminars in Thrombosis and Hemostasis·Matthew J StottsNicolas M Intagliata
Nov 22, 2020·Journal of Thrombosis and Haemostasis : JTH·Fien A von MeijenfeldtWilliam Bernal
Oct 31, 2020·Journal of Thrombosis and Haemostasis : JTH·Sarah BosTon Lisman
Mar 17, 2021·Journal of Thrombosis and Haemostasis : JTH·Bente P van den BoomTon Lisman
Aug 9, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ellen G DrieverTon Lisman
May 28, 2021·Journal of Hepatology·William BernalPhilippe Meersseman
Jul 18, 2021·Liver International : Official Journal of the International Association for the Study of the Liver·Ton Lisman, Bogdan Procopet
Dec 12, 2021·Liver International : Official Journal of the International Association for the Study of the Liver·Annabel BlasiTon Lisman

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