Diagnosis of disorders in the coagulation system, assessment of the risk of hemorrhagic complications in severe cirrhosis/liver diseases according to global screening tests of the hemostasis system and principles for their correction: guidelines

Abstract

Hemostasis disorders in cirrhosis / severe liver disease are complex, as they affect both pro- and anticoagulant factors, as well as pro- and antifibrinolytic components. Most of the tests that are used in clinical practice to assess coagulation do not take into account the compensatory capabilities of this system as a whole. This document provides guidance for the optimal application and interpretation of global screening tests in the assessment of hemostasis in cirrhosis/severe liver disease, analysis of risk factor of spontaneous and perioperative hemorrhagic complications in these patients, and possible ways to correct them. Thrombocytopenia is one of the most common hematological abnormalities in cirrhosis/ severe liver disease. The frequency of thrombocytopenia in such patients at the stage of liver cirrhosis is 70%, at the pre-cirrhotic stage – 6%. The latest scientific data on the use of thrombopoietin receptor agonists in chronic liver diseases are presented: which patients are the best candidates for a such of therapy. The rationality and limitations in prescribing blood components to patients with liver cirrhosis/severe liver diseases are described. Emphasis is placed on the fact that a number of hemorrhagic complications develop for other non-coagulopathic reasons: decompensated portal hypertension, traumatization of a varicose vein with trophic wall disorders, etc. Data are presented on the use of viscoelastic tests to optimize the management of patients with liver cirrhosis, which simultaneously assess the four main known components of the hemostasis system: the coagulation cascade, platelets, anticoagulant mechanisms and the fibrinolysis system. These tests allow optimization of transfusion of blood components in such patients and should be further studied. Research in this very complex area of hepatology is ongoing and must continue.