Anticoagulation in Patients with Liver Cirrhosis (Literature Review)
https://doi.org/10.29413/ABS.2019-4.2.3
Abstract
Liver cirrhosis is accompanied by complex hemostatic disorders with an increase in the risk of both hemorrhagic and thrombotic complications. Reduced coagulation protein synthesis, such as factors II, VII, IX, X and thrombocytopenia are associated with an increased risk of bleeding. Reducing the synthesis of such anticoagulants as protein C, protein S, antithrombin III is accompanied by increased generation of thrombin, which leads to procoagulant status, increased risk of venous thrombosis, pulmonary embolism, and portal vein thrombosis. Activation of the coagulation cascade increases the risk of thrombosis, and also plays an important role in liver damage, contributing to the progression of fibrosis. Cirrhosis increases the risk of thromboembolic complications of atrial fibrillation.
Anticoagulants are necessary for the prevention of thrombosis and thromboembolic complications. However, there are no large prospective studies. There is insufficient data on the safety of anticoagulant therapy in cirrhosis. There are difficulties in monitoring anticoagulation in the application of vitamin K antagonists and low molecular weight heparins.
The review presents the available data on the use of warfarin, unfractionated heparin, low molecular weight heparins and direct oral anticoagulants in patients with liver cirrhosis, indicating the need for prevention of venous thrombosis in patients with risk factors, the possibility of preventing decompensation of cirrhosis, reducing the frequency of cardioembolic strokes in patients with atrial fibrillation.
About the Author
E. S. Eniseeva
Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Medical University
Russian Federation
Russian Federation
Elena S. Eniseeva – Cand. Sc. (Med.), Associate Professor at the Department of Cardiology and Functional Diagnostics; Associate Professor at the Department of Hospital Therapy
Yubileynyy 100, Irkutsk 664049; ul. Krasnogo Vosstaniya 1, Irkutsk 664003
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Review
For citations:
Eniseeva E.S. Anticoagulation in Patients with Liver Cirrhosis (Literature Review). Acta Biomedica Scientifica. 2019;4(2):23-28. (In Russ.) https://doi.org/10.29413/ABS.2019-4.2.3
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