EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

opposing drivers (Fig. 1), but the mechanistic significance of the parallel decrease of both procoagulants and anticoagulants in patients with chronic liver disease escaped attention for many years. As a consequence, chronic liver disease is still considered the epitome of acquired bleeding disorders and is featured as such in most hematology textbooks. The basic laboratory tests of coagulation (i.e., measurement of the prothrombin time and activated partial-thromboplastin time) have been used to assess the risk of bleeding. However, their results are poorly correlated with the onset and duration of bleeding after liver biopsy or other potentially hemorrhagic procedures. 2-7 These test results are also poorly correlated with the occurrence of gastrointestinal bleeding, the prototype of hemorrhagic events in patients with end-stage liver disease. 8,9 Additional evidence that argues against the clinical relevance of the coagulation defects as detected by conventional laboratory tests in determining the bleeding tendency in these patients can be drawn from the natural history of liver transplantation. In the past, this major surgical procedure required massive transfusions of plasma and other blood products to correct the marked abnormalities on tests of hemostasis (assessments of coagulation, platelets, and fibrinolysis) observed both preoperatively and perioperatively. The need for transfusions, however, has declined considerably over time — not because of any substantial change in medication, but rather because of improved surgical procedures. 10 Finally and most important, randomized clinical trials involving patients with chronic liver disease have shown that powerful procoagulant agents, such as recombinant activated factor VII, fail to control bleeding from the upper intestinal tract 11,12 or bleeding during liver transplantation, 13,14 even though the postinfusion prothrombin time is considerably shortened. 11 In this review, we consider the evidence regarding the balance in the hemostatic system (involving coagulation, platelets, and fibrinolysis).

https://www.nejm.org/doi/pdf/10.1056/NEJMra1011170

The Coagulopathy of Chronic Liver Disease

Icmje

Vascular disorders of the liver, although affecting less than 5/10,000 patients, collectively account for a number of rare conditions that represent an important health problem worldwide in the field of liver diseases. A common characteristic of most of these disorders is that they can cause non-cirrhotic portal hypertension with an ensuing high morbidity and mortality. In addition, special relevance addresses the fact that patients are usually young with an otherwise normal life expectancy that may be markedly shortened if they are not adequately managed. Advances in the knowledge of vascular liver disorders are hampered by the small number of cases and a limited number of studies assessing natural history, pathophysiology or therapy. However, in recent years, interest for these disorders has increased as reflected in the rise in the number of publications on this topic. In addition, EASL has encouraged this increased interest by sponsoring a monothematic conference in June 2012 in Tallinn on vascular disorders of the liver, and by proposing an EASL clinical practice guidelines on the issue. These guidelines will not cover all possible vascular disorders of the liver but are mainly based on the subjects discussed during the monothematic conference; Budd-Chiari syndrome, non-cirrhotic portal vein thrombosis, idiopathic portal hypertension, sinusoidal obstruction syndrome, hepatic vascular malformations in hereditary haemorrhagic telangiectasia and portal vein thrombosis in cirrhosis. Guidelines have been written according to published studies retrieved from Pubmed. The evidence and recommendations have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. The strength of evidence has been classified into three levels: high (A), moderate (B) or low quality (C), while the grade of recommendation in two levels: strong (1) or weak (2) (Table 1). The higher the quality of the evidence, the more likely a strong recommendation is warranted. Where no clear evidence existed, recommendations were based on agreed opinions of the writing committee members.

https://www.journal-of-hepatology.eu/article/S0168-8278(15)00547-4/pdf

EASL Clinical Practice Guidelines: Vascular diseases of the liver q

https://www.gastrojournal.org/article/S0016-5085(12)01011-6/pdf

Enoxaparin Prevents Portal Vein Thrombosis and Liver Decompensation in Patients With Advanced Cirrhosis

Enoxaparin Prevents Portal Vein Thrombosisand Liver Decompensation in Patients With Advanced Cirrhosis.

1186 anticoagulant therapy is safe and effective in preventing portal vein thrombosis (pvt) in advanced cirrhotic patients: a prospective randomized controlled study

Enoxaparin prevents portal vein thrombosis (pvt) and decompensation in advanced cirrhotic patients: final report of a prospective randomized controlled study

Ramona Zecchini

Papers

Enoxaparin Prevents Portal Vein Thrombosis and Liver Decompensation in Patients With Advanced Cirrhosis

Enoxaparin Prevents Portal Vein Thrombosisand Liver Decompensation in Patients With Advanced Cirrhosis.

1186 anticoagulant therapy is safe and effective in preventing portal vein thrombosis (pvt) in advanced cirrhotic patients: a prospective randomized controlled study

Enoxaparin prevents portal vein thrombosis (pvt) and decompensation in advanced cirrhotic patients: final report of a prospective randomized controlled study