Thromboprophylaxis in liver cirrhosis: No = Thromboprophylaxis in liver cirrhosis: No

다국어 초록 (Multilingual Abstract)

Most of clinical practitioners have believed that patients with liver cirrhosis have a bleeding tendency related to lack of coagulation factors that occur as a consequence of the liver dysfunction. However, decreased levels of the procoagulants are also accompanied by decreases in levels of natural anticoagulants such as antithrombin, protein C and protein S. Therefore, the coagulation system in cirrhotic patients is re-balanced by these two opposing factors. To date, there are no well-established assays for correctly evaluating the coagulability status in cirrhotic patients. Now it is believed that patients with cirrhosis are not naturally anticoagulated and at risk for thrombotic complications. Physicians consider the active anticoagulation for the prophylaxis and treatment of portal vein thrombosis and/or venous thromboembolism (VTE) in cirrhotic patients with high risk of thrombosis. Simultaneously, they have safety concerns regarding the risk of bleeding related to anticoagulants when used in people with advanced liver disease, especially if there is significant thrombocytopenia, and/or the presence of varices. Therefore, the decision about the use of VTE prophylaxis in patients with cirrhosis should be made on a case-by-case basis after consideration of risk factor assessment for VTE. Further prospective studies are required to determine not only if cirrhotic patients benefit from receiving anticoagulation therapy in preventing VTE, but also which prophylactic regimen is most appropriate.