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Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

Summary

AI Generated

Coagulation abnormalities and thrombocytopenia are integral features of advanced chronic liver disease with established roles in prognostic assessment and clinical evaluation.

  • The International Normalised Ratio for prothrombin time is incorporated into the MELD score, which is commonly used to assess prognosis and determine the need for liver transplantation in patients with cirrhosis.
  • Thrombocytopenia in chronic liver disease is mainly related to hypersplenism and decreased synthesis of thrombopoietin by the liver.
  • Thrombocytopenia can be used to identify the presence of portal hypertension and decreased liver function in patients with chronic liver disease.
  • This material provides foundational context on hemostatic abnormalities in cirrhosis relevant to hepatologists and clinicians managing advanced liver disease.
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Intagliata NM, Argo CK, Stine JG, et al. Concepts and controversies in haemostasis and thrombosis associated with liver disease: Proceedings of the 7th International Coagulation in Liver Disease Conference. Thromb Haemost 2018; 118: 1491–1506. [Link]
2.
Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134–139. [Link]
3.
Giannini EG and Peck-Radosavljevic M. Platelet dysfunction: status of thrombopoietin in thrombocytopenia associated with chronic liver failure. Semin Thromb Hemost 2015; 41: 455–461. [Link]
4.
Tripodi A and Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147–156. [Link]
5.
Intagliata NM, Davis JPE and Caldwell SH. Coagulation pathways, hemostasis, and thrombosis in liver failure. Semin Respir Crit Care Med 2018; 39: 598–608. [Link]
6.
Stine JG, Intagliata NM, Shah NL, et al. Clinical cirrhosis dilemmas: Survey of practice from the 7th International Coagulation in Liver Disease Conference. Dig Dis Sci 2020; 65: 1334–1339. [Link]
7.
Northup PG, Sundaram V, Fallon MB, et al. Hypercoagulation and thrombophilia in liver disease. J Thromb Haemost 2008; 6: 2–9. [Link]
8.
Søgaard KK, Horváth-Puhó E, Grønbaek H, et al. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol 2009; 104: 96–101. [Link]
9.
Stine JG, Niccum BA, Zimmet AN, et al. Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis. Clin Transl Gastroenterol 2018; 9: 140. [Link]
10.
Tripodi A, Primignani M, Lemma L, et al. Evidence that low protein C contributes to the procoagulant imbalance in cirrhosis. J Hepatol 2013; 59: 265–270. [Link]
11.
Intagliata NM, Davis JPE, Lafond J, et al. Acute kidney injury is associated with low factor XIII in decompensated cirrhosis. Dig Liver Dis 2019; 51: 1409–1415. [Link]
12.
Zanetto A, Rinder HM, Campello E, et al. Acute kidney injury in decompensated cirrhosis is associated with both hypo- and hyper-coagulable features. Hepatology 2020; 72: 1327–1340. [Link]
13.
Jakab SS and Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis 2020; 24: 335–350. [Link]
14.
Lisotti A, Azzaroli F, Buonfiglioli F, et al. Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis. Hepatology 2014; 59: 643–650. [Link]
15.
Burton JR Jr, Liangpunsakul S, Lapidus J, et al. Validation of a multivariate model predicting presence and size of varices. J Clin Gastroenterol 2007; 41: 609–615. [Link]
16.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319: 983–989. [Link]
17.
Basili S, Raparelli V, Napoleone L, et al. Platelet count does not predict bleeding in cirrhotic patients: results from the PRO-LIVER Study. Am J Gastroenterol 2018; 113: 368–375. [Link]
18.
Quick AJ. The prothrombin in hemophilia and in obstructive jaundice. J Biol Chem 1935; 109: 73–74. [Link]
19.
Tripodi A, Caldwell SH, Hoffman M, et al. Review article: the prothrombin time test as a measure of bleeding risk and prognosis in liver disease. Aliment Pharmacol Ther 2007; 26: 141–148. [Link]
20.
Trotter JF, Olson J, Lefkowitz J, et al. Changes in international normalized ratio (INR) and model for endstage liver disease (MELD) based on selection of clinical laboratory. Am J Transplant 2007; 7: 1624–1628. [Link]
21.
Patel IJ, Rahim S, Davidson JC, et al. Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions—Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30: 1168–1184. [Link]
22.
Ewe K. Bleeding after liver biopsy does not correlate with indices of peripheral coagulation. Dig Dis Sci 1981; 26: 388–393. [Link]
23.
Grabau CM, Crago SF, Hoff LK, et al. Performance standards for therapeutic abdominal paracentesis. Hepatology 2004; 40: 484–488. [Link]
24.
Vieira da Rocha EC, D'Amico EA, Caldwell SH, et al. A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation. Clin Gastroenterol Hepatol 2009; 7: 988–993. [Link]
25.
Giannini EG, Greco A, Marenco S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol 2010; 8: 899–902. [Link]
26.
Fortea JI, Puente A, Ezcurra I, et al. Management of haemostatic alterations and associated disorders in cirrhosis in Spain: a national survey. Dig Liver Dis 2019; 51: 95–103. [Link]
27.
Desborough MJ, Hockley B, Sekhar M, et al. Patterns of blood component use in cirrhosis: a nationwide study. Liver Int 2016; 36: 522–529. [Link]
28.
Giannini EG, Stravitz RT and Caldwell SH. Correction of hemostatic abnormalities and portal pressure variations in patients with cirrhosis. Hepatology 2014; 60: 1442. [Link]
29.
Lisman T, Kleiss S, Patel VC, et al. In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis. Liver Int 2018; 38: 1988–1996. [Link]
30.
Bernal W, Caldwell SH and Lisman T. Nails in the coffin of fresh frozen plasma to prevent or treat bleeding in cirrhosis? J Hepatol 2020; 72: 12–13. [Link]
31.
Rassi AB, d'Amico EA, Tripodi A, et al. Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation. J Hepatol 2020; 72: 85–94. [Link]
32.
Giannini EG. Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options. Aliment Pharmacol Ther 2006; 23: 1055–1065. [Link]
33.
Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003; 52: 1200–1205. [Link]
34.
Witters P, Freson K, Verslype C, et al. Review article: blood platelet number and function in chronic liver disease and cirrhosis. Aliment Pharmacol Ther 2008; 27: 1017–1029. [Link]
35.
Lisman T, Bongers TN, Adelmeijer J, et al. Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatology 2006; 44: 53–61. [Link]
36.
Reuken PA, Kussmann A, Kiehntopf M, et al. Imbalance of von Willebrand factor and its cleaving protease ADAMTS13 during systemic inflammation superimposed on advanced cirrhosis. Liver Int 2015; 35: 37–45. [Link]
37.
Ault MJ, Rosen BT, Scher J, et al. Thoracentesis outcomes: a 12-year experience. Thorax 2015; 70: 127–132. [Link]
38.
Perdigão JP, de Almeida PC, Rocha TD, et al. Postoperative bleeding after dental extraction in liver pretransplant patients. J Oral Maxillofac Surg 2012; 70: e177–e184. [Link]
39.
Giannini EG, Giambruno E, Brunacci M, et al. Low fibrinogen levels are associated with bleeding after varices ligation in thrombocytopenic cirrhotic patients. Ann Hepatol 2018; 17: 830–835. [Link]
40.
Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol 2010; 8: 877–883. [Link]
41.
Park JG, Park SY, Tak WY, et al. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years. Clin Radiol 2017; 72: 692.e9–692.e15. [Link]
42.
Khemichian S and Terrault NA. Thrombopoietin receptor agonists in patients with chronic liver disease. Semin Thromb Hemost 2020; 46: 682–692. [Link]
43.
O'Leary JG, Greenberg CS, Patton HM, et al. AGA Clinical Practice Update: Coagulation in cirrhosis. Gastroenterology 2019; 157: 34–43.e1. [Link]
44.
Simonetto DA, Singal AK, Garcia-Tsao G, et al. ACG clinical guideline: disorders of the hepatic and mesenteric circulation. Am J Gastroenterol 2020; 115: 18–40. [Link]
45.
Bernal W, Jalan R, Quaglia A, et al. Acute-on-chronic liver failure. Lancet 2015; 386: 1576–1587. [Link]
46.
Bajaj JS. Defining acute-on-chronic liver failure: will East and West ever meet? Gastroenterology 2013; 144: 1337–1339. [Link]
47.
Moreau R, Jalan R, Ginès P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437. [Link]
48.
Bernardi M, Moreau R, Angeli P, et al. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol 2015; 63: 1272–1284. [Link]
49.
Dong V and Karvellas CJ. Acute-on-chronic liver failure: Objective admission and support criteria in the intensive care unit. JHEP Rep. 2019; 1: 44–52. [Link]
50.
Blasi A, Calvo A, Prado V, et al. Coagulation failure in patients with acute-on-chronic liver failure and decompensated cirrhosis: beyond the international normalized ratio. Hepatology 2018; 68: 2325–2337. [Link]
51.
Blasi A, Patel VC, Adelmeijer J, et al. Mixed fibrinolytic phenotypes in decompensated cirrhosis and acute-on-chronic liver failure with hypofibrinolysis in those with complications and poor survival. Hepatology 2020; 71: 1381–1390. [Link]
52.
Fisher C, Patel VC, Stoy SH, et al. Balanced haemostasis with both hypo- and hyper-coagulable features in critically ill patients with acute-on-chronic-liver failure. J Crit Care 2018; 43: 54–60. [Link]
53.
Premkumar M, Saxena P, Rangegowda D, et al. Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute-on-chronic liver failure: An observational cohort study. Liver Int 2019; 39: 694–704. [Link]
54.
Shukla A and Jain A. Association of acute-on-chronic liver failure with vascular liver diseases. Hepatol Int 2019; 13:399–402. [Link]
55.
Lin S, Wang M, Zhu Y, et al. Hemorrhagic complications following abdominal paracentesis in acute on chronic liver failure: a propensity score analysis. Medicine (Baltimore). 2015; 94: e2225. [Link]
56.
Cruz-Ramón V, Chinchilla-López P, Ramírez-Pérez O, et al. Thrombosis of the portal venous system in cirrhotic vs. non-cirrhotic patients. Ann Hepatol 2018; 17: 476–481. [Link]
57.
Intagliata NM, Caldwell SH and Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156: 1582–1599. [Link]
58.
Hagerty T and Rich MW. Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance. Cleve Clin J Med 2017; 84: 35–40. [Link]
59.
Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 2016; 100: 126–133. [Link]
60.
Pettinari I, Vukotic R, Stefanescu H, et al. Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol 2019; 114: 258–266. [Link]
61.
Delgado MG, Seijo S, Yepes I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10: 776–783. [Link]
62.
Villa E, Cammà C, Marietta M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143: 1253–1260. [Link]
63.
Calvaruso V, Maimone S, Gatt A, et al. Coagulation and fibrosis in chronic liver disease. Gut 2008; 57: 1722–1727. [Link]
64.
Davis JPE and Caldwell SH. Healing gone wrong: convergence of hemostatic pathways and liver fibrosis? Clin Sci (Lond) 2020; 134: 2189–2201. [Link]
65.
Giannini EG, Stravitz RT and Caldwell SH. Portal vein thrombosis and chronic liver disease progression: The closer you look the more you see. Hepatology 2016; 63: 342–343. [Link]
66.
Luca A, Caruso S, Milazzo M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology 2012; 265: 124–132. [Link]
67.
Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology 2015; 61: 660–667. [Link]
68.
Intagliata NM, Henry ZH, Maitland H, et al. Direct oral anticoagulants in cirrhosis patients pose similar risks of bleeding when compared to traditional anticoagulation. Dig Dis Sci 2016; 61: 1721–1727. [Link]
69.
Naymagon L, Tremblay D, Zubizarreta N, et al. The efficacy and safety of direct oral anticoagulants in noncirrhotic portal vein thrombosis. Blood Adv 2020; 4: 655–666. [Link]
70.
Rodriguez-Castro KI, Vitale A, Fadin M, et at. A prediction model for successful anticoagulation in cirrhotic portal vein thrombosis. Eur J Gastroenterol Hepatol 2019; 31: 34–42. [Link]
71.
Giannini EG and Savarino V. Which anticoagulant drug should be used to treat portal vein thrombosis in patients with chronic liver disease? Clin Gastroenterol Hepatol 2013; 11: 103. [Link]
72.
Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest 2010; 138: 1093–1100. [Link]
73.
Zhang S, Meng H, Chen Q, et al. Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome? Aging Clin Exp Res 2020; 32: 1435–1442. [Link]
74.
Olson ST, Richard B, Izaguirre G, et al. Molecular mechanisms of antithrombin-heparin regulation of blood clotting proteinases. A paradigm for understanding proteinase regulation by serpin family protein proteinase inhibitors. Biochimie 2010; 92: 1587–1596. [Link]
75.
Bechmann LP, Sichau M, Wichert M, et al. Low-molecular-weight heparin in patients with advanced cirrhosis. Liver Int 2011; 31: 75–82. [Link]
76.
Goodpasture EW. Fibrinolysis in chronic hepatic insufficiency. Bull Johns Hopkins Hosp 1914; 25: 330–336.
77.
Joist JH. AICF and DIC in liver cirrhosis: expressions of a hypercoagulable state. Am J Gastroenterol 1999; 94: 2801–2803. [Link]
78.
Rijken DC, Kock EL, Guimarães AH, et al. Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests. J Thromb Haemost 2012; 10: 2116–2222. [Link]
79.
de Franchis R, on behalf of the Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743–752. [Link]
80.
Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65: 310–335. [Link]
81.
DeAngelis GA, Khot R, Haskal ZJ, et al. Bleeding risk and management in interventional procedures in chronic liver disease. J Vasc Interv Radiol 2016; 27: 1665–1674. [Link]
82.
Ben-Ari Z, Panagou M, Patch D, et al. Hypercoagulability in patients with primary biliary cirrhosis and primary sclerosing cholangitis evaluated by thrombelastography. J Hepatol 1997; 26: 554–559. [Link]
83.
Montalto P, Vlachogiannakos J, Cox DJ, et al. Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study. J Hepatol 2002; 37: 463–470. [Link]

Abstract

Alteration of common coagulation tests and thrombocytopenia represent an integral part of the clinical picture of patients with advanced chronic liver disease. As such, the International Normalised Ratio (INR) for prothrombin time is part of the Model for End-stage Liver Disease (MELD) score, which is commonly used to assess prognosis and the need for liver transplantation in patients with cirrhosis. Thrombocytopenia—being mainly related to hypersplenism and decreased synthesis of thrombopoietin by the liver—can also be used to identify the presence of portal hypertension and decreased liver function in patients with chronic liver disease.


Topics

Hepatobiliary

Citation

Giannini EG and Caldwell SH. Mistakes in coagulation in liver disease and how to avoid them. UEG Education 2021; 21: 29–34.

Published

2021

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Intagliata NM, Argo CK, Stine JG, et al. Concepts and controversies in haemostasis and thrombosis associated with liver disease: Proceedings of the 7th International Coagulation in Liver Disease Conference. Thromb Haemost 2018; 118: 1491–1506. [Link]
2.
Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134–139. [Link]
3.
Giannini EG and Peck-Radosavljevic M. Platelet dysfunction: status of thrombopoietin in thrombocytopenia associated with chronic liver failure. Semin Thromb Hemost 2015; 41: 455–461. [Link]
4.
Tripodi A and Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147–156. [Link]
5.
Intagliata NM, Davis JPE and Caldwell SH. Coagulation pathways, hemostasis, and thrombosis in liver failure. Semin Respir Crit Care Med 2018; 39: 598–608. [Link]
6.
Stine JG, Intagliata NM, Shah NL, et al. Clinical cirrhosis dilemmas: Survey of practice from the 7th International Coagulation in Liver Disease Conference. Dig Dis Sci 2020; 65: 1334–1339. [Link]
7.
Northup PG, Sundaram V, Fallon MB, et al. Hypercoagulation and thrombophilia in liver disease. J Thromb Haemost 2008; 6: 2–9. [Link]
8.
Søgaard KK, Horváth-Puhó E, Grønbaek H, et al. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol 2009; 104: 96–101. [Link]
9.
Stine JG, Niccum BA, Zimmet AN, et al. Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis. Clin Transl Gastroenterol 2018; 9: 140. [Link]
10.
Tripodi A, Primignani M, Lemma L, et al. Evidence that low protein C contributes to the procoagulant imbalance in cirrhosis. J Hepatol 2013; 59: 265–270. [Link]
11.
Intagliata NM, Davis JPE, Lafond J, et al. Acute kidney injury is associated with low factor XIII in decompensated cirrhosis. Dig Liver Dis 2019; 51: 1409–1415. [Link]
12.
Zanetto A, Rinder HM, Campello E, et al. Acute kidney injury in decompensated cirrhosis is associated with both hypo- and hyper-coagulable features. Hepatology 2020; 72: 1327–1340. [Link]
13.
Jakab SS and Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis 2020; 24: 335–350. [Link]
14.
Lisotti A, Azzaroli F, Buonfiglioli F, et al. Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis. Hepatology 2014; 59: 643–650. [Link]
15.
Burton JR Jr, Liangpunsakul S, Lapidus J, et al. Validation of a multivariate model predicting presence and size of varices. J Clin Gastroenterol 2007; 41: 609–615. [Link]
16.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319: 983–989. [Link]
17.
Basili S, Raparelli V, Napoleone L, et al. Platelet count does not predict bleeding in cirrhotic patients: results from the PRO-LIVER Study. Am J Gastroenterol 2018; 113: 368–375. [Link]
18.
Quick AJ. The prothrombin in hemophilia and in obstructive jaundice. J Biol Chem 1935; 109: 73–74. [Link]
19.
Tripodi A, Caldwell SH, Hoffman M, et al. Review article: the prothrombin time test as a measure of bleeding risk and prognosis in liver disease. Aliment Pharmacol Ther 2007; 26: 141–148. [Link]
20.
Trotter JF, Olson J, Lefkowitz J, et al. Changes in international normalized ratio (INR) and model for endstage liver disease (MELD) based on selection of clinical laboratory. Am J Transplant 2007; 7: 1624–1628. [Link]
21.
Patel IJ, Rahim S, Davidson JC, et al. Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions—Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30: 1168–1184. [Link]
22.
Ewe K. Bleeding after liver biopsy does not correlate with indices of peripheral coagulation. Dig Dis Sci 1981; 26: 388–393. [Link]
23.
Grabau CM, Crago SF, Hoff LK, et al. Performance standards for therapeutic abdominal paracentesis. Hepatology 2004; 40: 484–488. [Link]
24.
Vieira da Rocha EC, D'Amico EA, Caldwell SH, et al. A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation. Clin Gastroenterol Hepatol 2009; 7: 988–993. [Link]
25.
Giannini EG, Greco A, Marenco S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol 2010; 8: 899–902. [Link]
26.
Fortea JI, Puente A, Ezcurra I, et al. Management of haemostatic alterations and associated disorders in cirrhosis in Spain: a national survey. Dig Liver Dis 2019; 51: 95–103. [Link]
27.
Desborough MJ, Hockley B, Sekhar M, et al. Patterns of blood component use in cirrhosis: a nationwide study. Liver Int 2016; 36: 522–529. [Link]
28.
Giannini EG, Stravitz RT and Caldwell SH. Correction of hemostatic abnormalities and portal pressure variations in patients with cirrhosis. Hepatology 2014; 60: 1442. [Link]
29.
Lisman T, Kleiss S, Patel VC, et al. In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis. Liver Int 2018; 38: 1988–1996. [Link]
30.
Bernal W, Caldwell SH and Lisman T. Nails in the coffin of fresh frozen plasma to prevent or treat bleeding in cirrhosis? J Hepatol 2020; 72: 12–13. [Link]
31.
Rassi AB, d'Amico EA, Tripodi A, et al. Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation. J Hepatol 2020; 72: 85–94. [Link]
32.
Giannini EG. Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options. Aliment Pharmacol Ther 2006; 23: 1055–1065. [Link]
33.
Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003; 52: 1200–1205. [Link]
34.
Witters P, Freson K, Verslype C, et al. Review article: blood platelet number and function in chronic liver disease and cirrhosis. Aliment Pharmacol Ther 2008; 27: 1017–1029. [Link]
35.
Lisman T, Bongers TN, Adelmeijer J, et al. Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatology 2006; 44: 53–61. [Link]
36.
Reuken PA, Kussmann A, Kiehntopf M, et al. Imbalance of von Willebrand factor and its cleaving protease ADAMTS13 during systemic inflammation superimposed on advanced cirrhosis. Liver Int 2015; 35: 37–45. [Link]
37.
Ault MJ, Rosen BT, Scher J, et al. Thoracentesis outcomes: a 12-year experience. Thorax 2015; 70: 127–132. [Link]
38.
Perdigão JP, de Almeida PC, Rocha TD, et al. Postoperative bleeding after dental extraction in liver pretransplant patients. J Oral Maxillofac Surg 2012; 70: e177–e184. [Link]
39.
Giannini EG, Giambruno E, Brunacci M, et al. Low fibrinogen levels are associated with bleeding after varices ligation in thrombocytopenic cirrhotic patients. Ann Hepatol 2018; 17: 830–835. [Link]
40.
Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol 2010; 8: 877–883. [Link]
41.
Park JG, Park SY, Tak WY, et al. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years. Clin Radiol 2017; 72: 692.e9–692.e15. [Link]
42.
Khemichian S and Terrault NA. Thrombopoietin receptor agonists in patients with chronic liver disease. Semin Thromb Hemost 2020; 46: 682–692. [Link]
43.
O'Leary JG, Greenberg CS, Patton HM, et al. AGA Clinical Practice Update: Coagulation in cirrhosis. Gastroenterology 2019; 157: 34–43.e1. [Link]
44.
Simonetto DA, Singal AK, Garcia-Tsao G, et al. ACG clinical guideline: disorders of the hepatic and mesenteric circulation. Am J Gastroenterol 2020; 115: 18–40. [Link]
45.
Bernal W, Jalan R, Quaglia A, et al. Acute-on-chronic liver failure. Lancet 2015; 386: 1576–1587. [Link]
46.
Bajaj JS. Defining acute-on-chronic liver failure: will East and West ever meet? Gastroenterology 2013; 144: 1337–1339. [Link]
47.
Moreau R, Jalan R, Ginès P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437. [Link]
48.
Bernardi M, Moreau R, Angeli P, et al. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol 2015; 63: 1272–1284. [Link]
49.
Dong V and Karvellas CJ. Acute-on-chronic liver failure: Objective admission and support criteria in the intensive care unit. JHEP Rep. 2019; 1: 44–52. [Link]
50.
Blasi A, Calvo A, Prado V, et al. Coagulation failure in patients with acute-on-chronic liver failure and decompensated cirrhosis: beyond the international normalized ratio. Hepatology 2018; 68: 2325–2337. [Link]
51.
Blasi A, Patel VC, Adelmeijer J, et al. Mixed fibrinolytic phenotypes in decompensated cirrhosis and acute-on-chronic liver failure with hypofibrinolysis in those with complications and poor survival. Hepatology 2020; 71: 1381–1390. [Link]
52.
Fisher C, Patel VC, Stoy SH, et al. Balanced haemostasis with both hypo- and hyper-coagulable features in critically ill patients with acute-on-chronic-liver failure. J Crit Care 2018; 43: 54–60. [Link]
53.
Premkumar M, Saxena P, Rangegowda D, et al. Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute-on-chronic liver failure: An observational cohort study. Liver Int 2019; 39: 694–704. [Link]
54.
Shukla A and Jain A. Association of acute-on-chronic liver failure with vascular liver diseases. Hepatol Int 2019; 13:399–402. [Link]
55.
Lin S, Wang M, Zhu Y, et al. Hemorrhagic complications following abdominal paracentesis in acute on chronic liver failure: a propensity score analysis. Medicine (Baltimore). 2015; 94: e2225. [Link]
56.
Cruz-Ramón V, Chinchilla-López P, Ramírez-Pérez O, et al. Thrombosis of the portal venous system in cirrhotic vs. non-cirrhotic patients. Ann Hepatol 2018; 17: 476–481. [Link]
57.
Intagliata NM, Caldwell SH and Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156: 1582–1599. [Link]
58.
Hagerty T and Rich MW. Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance. Cleve Clin J Med 2017; 84: 35–40. [Link]
59.
Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 2016; 100: 126–133. [Link]
60.
Pettinari I, Vukotic R, Stefanescu H, et al. Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol 2019; 114: 258–266. [Link]
61.
Delgado MG, Seijo S, Yepes I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10: 776–783. [Link]
62.
Villa E, Cammà C, Marietta M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143: 1253–1260. [Link]
63.
Calvaruso V, Maimone S, Gatt A, et al. Coagulation and fibrosis in chronic liver disease. Gut 2008; 57: 1722–1727. [Link]
64.
Davis JPE and Caldwell SH. Healing gone wrong: convergence of hemostatic pathways and liver fibrosis? Clin Sci (Lond) 2020; 134: 2189–2201. [Link]
65.
Giannini EG, Stravitz RT and Caldwell SH. Portal vein thrombosis and chronic liver disease progression: The closer you look the more you see. Hepatology 2016; 63: 342–343. [Link]
66.
Luca A, Caruso S, Milazzo M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology 2012; 265: 124–132. [Link]
67.
Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology 2015; 61: 660–667. [Link]
68.
Intagliata NM, Henry ZH, Maitland H, et al. Direct oral anticoagulants in cirrhosis patients pose similar risks of bleeding when compared to traditional anticoagulation. Dig Dis Sci 2016; 61: 1721–1727. [Link]
69.
Naymagon L, Tremblay D, Zubizarreta N, et al. The efficacy and safety of direct oral anticoagulants in noncirrhotic portal vein thrombosis. Blood Adv 2020; 4: 655–666. [Link]
70.
Rodriguez-Castro KI, Vitale A, Fadin M, et at. A prediction model for successful anticoagulation in cirrhotic portal vein thrombosis. Eur J Gastroenterol Hepatol 2019; 31: 34–42. [Link]
71.
Giannini EG and Savarino V. Which anticoagulant drug should be used to treat portal vein thrombosis in patients with chronic liver disease? Clin Gastroenterol Hepatol 2013; 11: 103. [Link]
72.
Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest 2010; 138: 1093–1100. [Link]
73.
Zhang S, Meng H, Chen Q, et al. Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome? Aging Clin Exp Res 2020; 32: 1435–1442. [Link]
74.
Olson ST, Richard B, Izaguirre G, et al. Molecular mechanisms of antithrombin-heparin regulation of blood clotting proteinases. A paradigm for understanding proteinase regulation by serpin family protein proteinase inhibitors. Biochimie 2010; 92: 1587–1596. [Link]
75.
Bechmann LP, Sichau M, Wichert M, et al. Low-molecular-weight heparin in patients with advanced cirrhosis. Liver Int 2011; 31: 75–82. [Link]
76.
Goodpasture EW. Fibrinolysis in chronic hepatic insufficiency. Bull Johns Hopkins Hosp 1914; 25: 330–336.
77.
Joist JH. AICF and DIC in liver cirrhosis: expressions of a hypercoagulable state. Am J Gastroenterol 1999; 94: 2801–2803. [Link]
78.
Rijken DC, Kock EL, Guimarães AH, et al. Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests. J Thromb Haemost 2012; 10: 2116–2222. [Link]
79.
de Franchis R, on behalf of the Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743–752. [Link]
80.
Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65: 310–335. [Link]
81.
DeAngelis GA, Khot R, Haskal ZJ, et al. Bleeding risk and management in interventional procedures in chronic liver disease. J Vasc Interv Radiol 2016; 27: 1665–1674. [Link]
82.
Ben-Ari Z, Panagou M, Patch D, et al. Hypercoagulability in patients with primary biliary cirrhosis and primary sclerosing cholangitis evaluated by thrombelastography. J Hepatol 1997; 26: 554–559. [Link]
83.
Montalto P, Vlachogiannakos J, Cox DJ, et al. Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study. J Hepatol 2002; 37: 463–470. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Intagliata NM, Argo CK, Stine JG, et al. Concepts and controversies in haemostasis and thrombosis associated with liver disease: Proceedings of the 7th International Coagulation in Liver Disease Conference. Thromb Haemost 2018; 118: 1491–1506. [Link]
2.
Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134–139. [Link]
3.
Giannini EG and Peck-Radosavljevic M. Platelet dysfunction: status of thrombopoietin in thrombocytopenia associated with chronic liver failure. Semin Thromb Hemost 2015; 41: 455–461. [Link]
4.
Tripodi A and Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147–156. [Link]
5.
Intagliata NM, Davis JPE and Caldwell SH. Coagulation pathways, hemostasis, and thrombosis in liver failure. Semin Respir Crit Care Med 2018; 39: 598–608. [Link]
6.
Stine JG, Intagliata NM, Shah NL, et al. Clinical cirrhosis dilemmas: Survey of practice from the 7th International Coagulation in Liver Disease Conference. Dig Dis Sci 2020; 65: 1334–1339. [Link]
7.
Northup PG, Sundaram V, Fallon MB, et al. Hypercoagulation and thrombophilia in liver disease. J Thromb Haemost 2008; 6: 2–9. [Link]
8.
Søgaard KK, Horváth-Puhó E, Grønbaek H, et al. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol 2009; 104: 96–101. [Link]
9.
Stine JG, Niccum BA, Zimmet AN, et al. Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis. Clin Transl Gastroenterol 2018; 9: 140. [Link]
10.
Tripodi A, Primignani M, Lemma L, et al. Evidence that low protein C contributes to the procoagulant imbalance in cirrhosis. J Hepatol 2013; 59: 265–270. [Link]
11.
Intagliata NM, Davis JPE, Lafond J, et al. Acute kidney injury is associated with low factor XIII in decompensated cirrhosis. Dig Liver Dis 2019; 51: 1409–1415. [Link]
12.
Zanetto A, Rinder HM, Campello E, et al. Acute kidney injury in decompensated cirrhosis is associated with both hypo- and hyper-coagulable features. Hepatology 2020; 72: 1327–1340. [Link]
13.
Jakab SS and Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis 2020; 24: 335–350. [Link]
14.
Lisotti A, Azzaroli F, Buonfiglioli F, et al. Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis. Hepatology 2014; 59: 643–650. [Link]
15.
Burton JR Jr, Liangpunsakul S, Lapidus J, et al. Validation of a multivariate model predicting presence and size of varices. J Clin Gastroenterol 2007; 41: 609–615. [Link]
16.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319: 983–989. [Link]
17.
Basili S, Raparelli V, Napoleone L, et al. Platelet count does not predict bleeding in cirrhotic patients: results from the PRO-LIVER Study. Am J Gastroenterol 2018; 113: 368–375. [Link]
18.
Quick AJ. The prothrombin in hemophilia and in obstructive jaundice. J Biol Chem 1935; 109: 73–74. [Link]
19.
Tripodi A, Caldwell SH, Hoffman M, et al. Review article: the prothrombin time test as a measure of bleeding risk and prognosis in liver disease. Aliment Pharmacol Ther 2007; 26: 141–148. [Link]
20.
Trotter JF, Olson J, Lefkowitz J, et al. Changes in international normalized ratio (INR) and model for endstage liver disease (MELD) based on selection of clinical laboratory. Am J Transplant 2007; 7: 1624–1628. [Link]
21.
Patel IJ, Rahim S, Davidson JC, et al. Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions—Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30: 1168–1184. [Link]
22.
Ewe K. Bleeding after liver biopsy does not correlate with indices of peripheral coagulation. Dig Dis Sci 1981; 26: 388–393. [Link]
23.
Grabau CM, Crago SF, Hoff LK, et al. Performance standards for therapeutic abdominal paracentesis. Hepatology 2004; 40: 484–488. [Link]
24.
Vieira da Rocha EC, D'Amico EA, Caldwell SH, et al. A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation. Clin Gastroenterol Hepatol 2009; 7: 988–993. [Link]
25.
Giannini EG, Greco A, Marenco S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol 2010; 8: 899–902. [Link]
26.
Fortea JI, Puente A, Ezcurra I, et al. Management of haemostatic alterations and associated disorders in cirrhosis in Spain: a national survey. Dig Liver Dis 2019; 51: 95–103. [Link]
27.
Desborough MJ, Hockley B, Sekhar M, et al. Patterns of blood component use in cirrhosis: a nationwide study. Liver Int 2016; 36: 522–529. [Link]
28.
Giannini EG, Stravitz RT and Caldwell SH. Correction of hemostatic abnormalities and portal pressure variations in patients with cirrhosis. Hepatology 2014; 60: 1442. [Link]
29.
Lisman T, Kleiss S, Patel VC, et al. In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis. Liver Int 2018; 38: 1988–1996. [Link]
30.
Bernal W, Caldwell SH and Lisman T. Nails in the coffin of fresh frozen plasma to prevent or treat bleeding in cirrhosis? J Hepatol 2020; 72: 12–13. [Link]
31.
Rassi AB, d'Amico EA, Tripodi A, et al. Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation. J Hepatol 2020; 72: 85–94. [Link]
32.
Giannini EG. Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options. Aliment Pharmacol Ther 2006; 23: 1055–1065. [Link]
33.
Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003; 52: 1200–1205. [Link]
34.
Witters P, Freson K, Verslype C, et al. Review article: blood platelet number and function in chronic liver disease and cirrhosis. Aliment Pharmacol Ther 2008; 27: 1017–1029. [Link]
35.
Lisman T, Bongers TN, Adelmeijer J, et al. Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatology 2006; 44: 53–61. [Link]
36.
Reuken PA, Kussmann A, Kiehntopf M, et al. Imbalance of von Willebrand factor and its cleaving protease ADAMTS13 during systemic inflammation superimposed on advanced cirrhosis. Liver Int 2015; 35: 37–45. [Link]
37.
Ault MJ, Rosen BT, Scher J, et al. Thoracentesis outcomes: a 12-year experience. Thorax 2015; 70: 127–132. [Link]
38.
Perdigão JP, de Almeida PC, Rocha TD, et al. Postoperative bleeding after dental extraction in liver pretransplant patients. J Oral Maxillofac Surg 2012; 70: e177–e184. [Link]
39.
Giannini EG, Giambruno E, Brunacci M, et al. Low fibrinogen levels are associated with bleeding after varices ligation in thrombocytopenic cirrhotic patients. Ann Hepatol 2018; 17: 830–835. [Link]
40.
Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol 2010; 8: 877–883. [Link]
41.
Park JG, Park SY, Tak WY, et al. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years. Clin Radiol 2017; 72: 692.e9–692.e15. [Link]
42.
Khemichian S and Terrault NA. Thrombopoietin receptor agonists in patients with chronic liver disease. Semin Thromb Hemost 2020; 46: 682–692. [Link]
43.
O'Leary JG, Greenberg CS, Patton HM, et al. AGA Clinical Practice Update: Coagulation in cirrhosis. Gastroenterology 2019; 157: 34–43.e1. [Link]
44.
Simonetto DA, Singal AK, Garcia-Tsao G, et al. ACG clinical guideline: disorders of the hepatic and mesenteric circulation. Am J Gastroenterol 2020; 115: 18–40. [Link]
45.
Bernal W, Jalan R, Quaglia A, et al. Acute-on-chronic liver failure. Lancet 2015; 386: 1576–1587. [Link]
46.
Bajaj JS. Defining acute-on-chronic liver failure: will East and West ever meet? Gastroenterology 2013; 144: 1337–1339. [Link]
47.
Moreau R, Jalan R, Ginès P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437. [Link]
48.
Bernardi M, Moreau R, Angeli P, et al. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol 2015; 63: 1272–1284. [Link]
49.
Dong V and Karvellas CJ. Acute-on-chronic liver failure: Objective admission and support criteria in the intensive care unit. JHEP Rep. 2019; 1: 44–52. [Link]
50.
Blasi A, Calvo A, Prado V, et al. Coagulation failure in patients with acute-on-chronic liver failure and decompensated cirrhosis: beyond the international normalized ratio. Hepatology 2018; 68: 2325–2337. [Link]
51.
Blasi A, Patel VC, Adelmeijer J, et al. Mixed fibrinolytic phenotypes in decompensated cirrhosis and acute-on-chronic liver failure with hypofibrinolysis in those with complications and poor survival. Hepatology 2020; 71: 1381–1390. [Link]
52.
Fisher C, Patel VC, Stoy SH, et al. Balanced haemostasis with both hypo- and hyper-coagulable features in critically ill patients with acute-on-chronic-liver failure. J Crit Care 2018; 43: 54–60. [Link]
53.
Premkumar M, Saxena P, Rangegowda D, et al. Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute-on-chronic liver failure: An observational cohort study. Liver Int 2019; 39: 694–704. [Link]
54.
Shukla A and Jain A. Association of acute-on-chronic liver failure with vascular liver diseases. Hepatol Int 2019; 13:399–402. [Link]
55.
Lin S, Wang M, Zhu Y, et al. Hemorrhagic complications following abdominal paracentesis in acute on chronic liver failure: a propensity score analysis. Medicine (Baltimore). 2015; 94: e2225. [Link]
56.
Cruz-Ramón V, Chinchilla-López P, Ramírez-Pérez O, et al. Thrombosis of the portal venous system in cirrhotic vs. non-cirrhotic patients. Ann Hepatol 2018; 17: 476–481. [Link]
57.
Intagliata NM, Caldwell SH and Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156: 1582–1599. [Link]
58.
Hagerty T and Rich MW. Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance. Cleve Clin J Med 2017; 84: 35–40. [Link]
59.
Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 2016; 100: 126–133. [Link]
60.
Pettinari I, Vukotic R, Stefanescu H, et al. Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol 2019; 114: 258–266. [Link]
61.
Delgado MG, Seijo S, Yepes I, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10: 776–783. [Link]
62.
Villa E, Cammà C, Marietta M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143: 1253–1260. [Link]
63.
Calvaruso V, Maimone S, Gatt A, et al. Coagulation and fibrosis in chronic liver disease. Gut 2008; 57: 1722–1727. [Link]
64.
Davis JPE and Caldwell SH. Healing gone wrong: convergence of hemostatic pathways and liver fibrosis? Clin Sci (Lond) 2020; 134: 2189–2201. [Link]
65.
Giannini EG, Stravitz RT and Caldwell SH. Portal vein thrombosis and chronic liver disease progression: The closer you look the more you see. Hepatology 2016; 63: 342–343. [Link]
66.
Luca A, Caruso S, Milazzo M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology 2012; 265: 124–132. [Link]
67.
Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology 2015; 61: 660–667. [Link]
68.
Intagliata NM, Henry ZH, Maitland H, et al. Direct oral anticoagulants in cirrhosis patients pose similar risks of bleeding when compared to traditional anticoagulation. Dig Dis Sci 2016; 61: 1721–1727. [Link]
69.
Naymagon L, Tremblay D, Zubizarreta N, et al. The efficacy and safety of direct oral anticoagulants in noncirrhotic portal vein thrombosis. Blood Adv 2020; 4: 655–666. [Link]
70.
Rodriguez-Castro KI, Vitale A, Fadin M, et at. A prediction model for successful anticoagulation in cirrhotic portal vein thrombosis. Eur J Gastroenterol Hepatol 2019; 31: 34–42. [Link]
71.
Giannini EG and Savarino V. Which anticoagulant drug should be used to treat portal vein thrombosis in patients with chronic liver disease? Clin Gastroenterol Hepatol 2013; 11: 103. [Link]
72.
Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest 2010; 138: 1093–1100. [Link]
73.
Zhang S, Meng H, Chen Q, et al. Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome? Aging Clin Exp Res 2020; 32: 1435–1442. [Link]
74.
Olson ST, Richard B, Izaguirre G, et al. Molecular mechanisms of antithrombin-heparin regulation of blood clotting proteinases. A paradigm for understanding proteinase regulation by serpin family protein proteinase inhibitors. Biochimie 2010; 92: 1587–1596. [Link]
75.
Bechmann LP, Sichau M, Wichert M, et al. Low-molecular-weight heparin in patients with advanced cirrhosis. Liver Int 2011; 31: 75–82. [Link]
76.
Goodpasture EW. Fibrinolysis in chronic hepatic insufficiency. Bull Johns Hopkins Hosp 1914; 25: 330–336.
77.
Joist JH. AICF and DIC in liver cirrhosis: expressions of a hypercoagulable state. Am J Gastroenterol 1999; 94: 2801–2803. [Link]
78.
Rijken DC, Kock EL, Guimarães AH, et al. Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests. J Thromb Haemost 2012; 10: 2116–2222. [Link]
79.
de Franchis R, on behalf of the Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743–752. [Link]
80.
Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65: 310–335. [Link]
81.
DeAngelis GA, Khot R, Haskal ZJ, et al. Bleeding risk and management in interventional procedures in chronic liver disease. J Vasc Interv Radiol 2016; 27: 1665–1674. [Link]
82.
Ben-Ari Z, Panagou M, Patch D, et al. Hypercoagulability in patients with primary biliary cirrhosis and primary sclerosing cholangitis evaluated by thrombelastography. J Hepatol 1997; 26: 554–559. [Link]
83.
Montalto P, Vlachogiannakos J, Cox DJ, et al. Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study. J Hepatol 2002; 37: 463–470. [Link]

Abstract

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

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Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Mike van Dooren, Elise A.J. de Savornin Lohman

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Guideline

ABSTRACT

Background

Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.

Methods

Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.

Results

A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9–47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.

Discussion

Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary Surgery

Citation

United European Gastroenterology Journal, 2025; 13:1133–1140

Published

2025

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Pradeep Mundre Pradeep Mundre, Hannah Gordon

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Malignancy in IBD with Hannah Gordon

Hannah Gordon, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Digestive Oncology IBD

Published

2026

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