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Coagulopathy of Liver Disease

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Trauma Induced Coagulopathy

Abstract

For many years, liver disease has been viewed as a bleeding diathesis; this dogma has now come under challenge with the discovery that some patients with liver disease are also at an increased risk of developing thrombosis. The current understanding is that in liver disease, the haemostatic balance remains as in normal individuals but is reset, with equally reduced levels of coagulant and anticoagulant proteins. Thus it is fragile and easily disturbed resulting in either bleeding or thrombosis, depending on the initial stimulus. This, along with the physiological derangements inherent in liver disease, adds many layers of complexity to the investigation and management of bleeding and thrombosis in patients with liver disease. This chapter aims to address these issues, firstly defining liver disease and its aetiologies, the pathophysiological mechanisms underlying the fragile haemostatic balance, interpretation of screening tests of coagulation in the context of liver disease and finally the management of bleeding and thrombosis in liver disease. Future research is discussed including global assays of coagulation, which provide a more accurate assessment of the haemostatic defect and current clinical trials assessing therapeutic options, such as tranexamic acid, in select clinical contexts.

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Authors and Affiliations

  1. Barts and the London School of Medicine and Dentistry, St Batholomew’s Hospital, Queen Mary University of London, West Smithfield, London, EC1A 7BE, UK

    Shahzaib Ahmad

  2. Thrombosis and Haemophilia Centre, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    Beverley J. Hunt

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  1. Shahzaib Ahmad
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Editors and Affiliations

  1. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Eduardo Gonzalez

  2. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Hunter B. Moore

  3. Dept of Surgery & Trauma Research Center, Univ of Colorado Sch of Med&Denver Healt, Denver, Colorado, USA

    Ernest E. Moore

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Ahmad, S., Hunt, B.J. (2016). Coagulopathy of Liver Disease. In: Gonzalez, E., Moore, H., Moore, E. (eds) Trauma Induced Coagulopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-28308-1_29

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