ArticleLiver international : official journal of the International Association for the Study of the Liver2018
In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Use of prothrombin complex concentrates in liver transplantation: a systematic review and meta-analysis.British journal of anaesthesia · 2025Pooled it
- Comparison of relaxed verses standard cut-offs of rotational thromboelastometry for guiding blood product use before invasive procedures in advanced cirrhosis: a randomized controlled trial.Hepatology international · 2026Trial
- Phase-specific dynamics of coagulation factors V, VIII, and XIII during liver transplantation: insights from a prospective study.Perioperative medicine (London, England) · 2026Article
- An Overview of Anticoagulant Drugs Pharmacology, Therapeutic Approaches, Limitations and Perspectives.Pharmaceutics · 2026Review
- Advances in the prevention and management of procedural bleeding in patients with cirrhosis.Hepatology international · 2025Review
- Prediction and prevention of post-procedural bleedings in patients with cirrhosis.Clinical and molecular hepatology · 2025Review
- Hematological abnormalities in liver cirrhosis.World journal of hepatology · 2024Review
- Direct oral anticoagulants in cirrhosis: Rationale and current evidence.JHEP reports : innovation in hepatology · 2024Review
- How to manage hemostasis in patients with liver disease during interventions.Hematology. American Society of Hematology. Education Program · 2023Review
- Fibrin clot quality in acutely ill cirrhosis patients: Relation with outcome and improvement with coagulation factor concentrates.Liver international : official journal of the International Association for the Study of the Liver · 2022Article
- Semi-automated thrombin dynamics applying the ST Genesia thrombin generation assay.Frontiers in cardiovascular medicine · 2022Article
- Heparins have adequate ex vivo anticoagulant effects in hospitalized patients with cirrhosis.Journal of thrombosis and haemostasis : JTH · 2021Article
- VWF/ADAMTS13 Imbalance, But Not Global Coagulation or Fibrinolysis, Is Associated With Outcome and Bleeding in Acute Liver Failure.Hepatology (Baltimore, Md.) · 2021Article
- Prophylactic fresh frozen plasma and platelet transfusion have a prothrombotic effect in patients with liver disease.Journal of thrombosis and haemostasis : JTH · 2021Article
- Efficacy of pro- and anticoagulant strategies in plasma of patients undergoing hepatobiliary surgery.Journal of thrombosis and haemostasis : JTH · 2020Article
- Prothrombin Complex Concentrates for Coagulopathy in Liver Disease: Single-Center, Clinical Experience in 105 Patients.Hepatology communications · 2019Article
- In vitro efficacy of pro- and anticoagulant strategies in compensated and acutely ill patients with cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2018Article
- Algorithms for managing coagulation disorders in liver disease.Hepatology international · 2018Review
- Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference.Thrombosis and haemostasis · 2018Article
- Direct Oral Anticoagulants for Portal Vein Thrombosis in Cirrhosis: From Pharmacology to Clinical Practice.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisReview
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10 authors.
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Abstract
BACKGROUND &
aimsA simultaneous decline in pro- and anticoagulant drivers in patients with liver diseases results in a "rebalanced" haemostatic system, even in acutely ill patients. Nevertheless, both bleeding and thrombotic events are common. Here, we explored efficacy of pro- and antihaemostatic strategies in compensated and acutely ill cirrhotics which may be unpredictable given the profound haemostatic changes.
methodsWe tested the effects in vitro of the addition of clinically relevant doses of commonly used pro- and antihaemostatic strategies in plasma from healthy individuals (n = 30) and patients with compensated (n = 18) and acutely decompensated cirrhosis (n = 18), and acute-on-chronic liver failure (n = 10). We used thrombin generation tests and fibrin clot permeability assays to assess potency of various approaches.
resultsFresh frozen plasma and recombinant factor VIIa modestly increased thrombin generation (10%-20%). Prothrombin complex concentrate increased thrombin generation two-fold in controls and 2-4-fold in patients. Clot permeability decreased after addition of fibrinogen concentrate by 51% in controls and by 50%-60% in patients. Low molecular weight heparin decreased thrombin generation by 18% in controls and by 23%-54% in patients. Similarly, dabigatran decreased thrombin generation by 33% in controls and by 47%-100% in patients. In contrast, rivaroxaban decreased thrombin generation by 55% in controls, but only by 11%-38% in patients.
conclusionsThese in vitro data suggest little prohaemostatic effect of fresh frozen plasma and recombinant factor VIIa in acutely ill cirrhotics, whereas prothrombin complex concentrate and fibrinogen concentrate clearly improved haemostasis. Furthermore, our data suggest the requirement for dose adjustments of commonly used anticoagulants in these patients.
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