2015, Number 1
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Ann Hepatol 2015; 14 (1)
Thrombosis and hemorrhage in the critically ill cirrhotic patients: five years retrospective prevalence study Jimena Muciño-
Muciño-Bermejo J, Carrillo-Esper R, Méndez-Sánchez N, Uribe M
Language: English
References: 21
Page: 93-98
PDF size: 78.88 Kb.
ABSTRACT
Background. Cirrhotic patients present a complex interaction between deficient synthetic liver function,
hemodynamic abnormalities and superimposed conditions that alter coagulation system. This alters both
coagulation and fibrinolytic processes,increasing bleeding and thrombosis risks. Particularly, critically ill
cirrhotic patients represent a diagnostic challenge since they have multiple comorbidities making the
thrombotic and bleeding risks unpredictable. The prevalence of bleeding and thrombosis in this subset of
patients remains poorly described. The main aim of this article is to describe the prevalence of thrombotic
and hemorrhagic complications in cirrhotic patients admitted between 2007 and 2012 at Médica Sur Clinic and
Foundation ICU.
Material and methods. We performed a five years retrospective study including every cirrhotic
patient admitted to ICU between January 2007 and December 2012.
Results. The incidence of hemorrhage
was 48.5%, the overall incidence of thrombotic complications was 13.66%. Variceal bleeding was
the most prevalent hemorrhagic event and portal vein thrombosis the most common thrombotic event. Factors
associated with presenting a bleeding episode included kidney injury, infection an thrombosis.
Factors associated with increased thrombotic risk included ascitis,infection and bleeding.
Conclusion. Critically
ill cirrhotic patients have an high risk for both thrombotic and bleeding episodes. The association
between the presence of bleeding and thrombotic events was statistically significant.
REFERENCES
Caldwell SH, Hoffman M, Lisman T, Macik BG, Northup PG, Reddy KR, Tripodi A, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology 2006; 44:1039-46.
Lisman T, Porte RJ. Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences. Blood 2010; 116: 878-5.
Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147-56.
Shah NL, Northup PG, Caldwell SH. A clinical survey of bleeding, thrombosis, and blood product use in decompensated cirrhosis patients. Ann Hepatol 2012 ; 11: 686-90.
Lippi G, Targher G, Favaloro EJ, Franchini M. Venous thromboembolism in chronic liver. Semin Thromb Hemost 2011; 37: 66-76.
Ferro D, Angelico F, Caldwell SH, Violi F. Bleeding and thrombosis in cirrhotic patients: what really matters? Dig Liver Dis 2012; 44: 275-9.
Caldwell S, Northup PG. Bleeding complication with liver biopsy: is it predictable? Clin Gastroenterol Hepatol 2010; 8: 826-9.
Caldwell S, Northup PG. Bleeding complication with liver biopsy: is it predictable? Clin Gastroenterol Hepatol 2010; 8: 826-9.
Gabr MA, Bessa SS, El-Zamarani EA. Portal vein thrombosis in Egyptian patients with liver cirrhosis: Role of methylenetetrahydrofolate reductase C677T gene mutation. Hepatol Res 2010; 40: 486-93.
Northup PG, McMahon MM, Ruhl AP, Altschuler SE, Volk- Bednarz A, Caldwell SH, Berg CL. Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. Am J Gastroenterol 2006; 101: 1524-8.
García-Fuster MJ, Abdilla N, Fabiá MJ, Fernández C, Oliver V, Forner M J. Venous thromboembolism and liver cirrhosis. Rev Esp Enferm Dig 2008; 100: 259-62.
Available at: http://www.who.int/mediacentre/factsheets/ fs312/es/ (visited March 20th, 2013).
Norma Oficial Mexicana NOM-015-SSA2-2010, Para la prevención, tratamiento y control de la diabetes mellitus.
World Health Organization. Obesity and Overweight. Available at: http://www.who.int/hpr/NPH/docs/gs_ obesity.pdf (2011).
Shah NL, Northup PG, Caldwell SH. A clinical survey of bleeding, thrombosis, and blood product use in decompensated cirrhosis patients. Ann Hepatol 2012; 11: 686-90.
Ferro D, Angelico F, Caldwell SH, Violi F. Bleeding and thrombosis in cirrhotic patients: what really matters? Dig Liver Dis 2012; 44: 275-9.
Grønbaek H, Johnsen SP, Jepsen P, Gislum M, Vilstrup H, Tage-Jensen U, Sørensen HT. Liver cirrhosis, other liver diseases, and risk of hospitalisation for intracerebral haemorrhage: a Danish population based case-control study. BMC Gastroenterol 2008; 8: 16.
Chen YH, Chen KY, Lin HC. Non-alcoholic cirrhosis and the risk of stroke: a 5-year follow-up study. Liver Int 2011; 31: 354-60.
Gabr MA, Bessa SS, El-Zamarani EA. Portal vein thrombosis in Egyptian patients with liver cirrhosis: Role of methylenetetrahydrofolate reductase C677T gene mutation. Hepatol Res 2010; 40: 486-93.
Northup PG, McMahon MM, Ruhl AP, Altschuler SE, Volk- Bednarz A, Caldwell SH, Berg CL. Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. Am J Gastroenterol 2006; 101: 1524-8.
García-Fuster MJ, Abdilla N, Fabiá MJ, Fernández C, Oliver V, Forner MJ. Venous thromboembolism and liver cirrhosis. Rev Esp Enferm Dig 2008; 100: 259-62.