Coagulation and cirrhosis: new insight].

S Ditisheim, N Goossens, L Spahr, A Hadengue

Service de gastroentérologie et hépatologie, Département des spécialités de médecine, HUG, Genève. saskia.i.ditisheim@hcuge.ch

Revue médicale suisse 2012 Sep 5

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The liver plays a key role in coagulation as all clotting factors except for factor VIII are synthetized by hepatocytes. In cirrhotic patients, there is a decrease of clotting factors and a thrombocytopenia. Those parameters usually modify routine coagulation tests and may suggest that cirrhotic patients are at a higher risk of bleeding. However, studies have shown that these patients are rather at risk for thrombosis. The reason is a concomitant decrease of coagulation inhibitors factors that is not detected in routine laboratory coagulation tests. The coagulation system in cirrhotic patient is a balance of pro and anti-coagulants. This balance may be affected by co-factors such as renal failure or infection. Artificial correction of laboratory values by transfusion of blood products may be rather deleterious (e.g. volume overload, TRALI).