ArticleJournal of thrombosis and haemostasis : JTH2021
The concept of rebalanced hemostasis in patients with liver disease: Communication from the ISTH SSC working group on hemostatic management of patients with liver disease.
Article in Journal of thrombosis and haemostasis : JTH, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 3 of them syntheses that pooled it.
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Who cites it
62 citing papers in PubMed, 3 syntheses or guidelines pooled it, 137 citations in OpenAlex.
- Recommendations for the safe use of direct oral anticoagulants in patients with cirrhosis based on a systematic review of pharmacokinetic, pharmacodynamic and safety data.European journal of clinical pharmacology · 2024Pooled it
- Thromboelastography-Guided Therapy Enhances Patient Blood Management in Cirrhotic Patients: A Meta-analysis Based on Randomized Controlled Trials.Seminars in thrombosis and hemostasis · 2023Pooled it
- The effects and safety of anticoagulation or antiplatelet therapy following TIPS in cirrhotic patients with portal hypertension: A meta-analysis.Frontiers in pharmacology · 2023Pooled it
- Rotational thromboelastometry versus conventional tests in decompensated cirrhotic children undergoing invasive procedures.Journal of pediatric gastroenterology and nutrition · 2026Trial
- Challenges in PT/INR harmonization across the total testing process.Biochemia medica · 2026Review
- [Acute management of bleeding complications and coagulation disorders in critically ill patients with liver cirrhosis].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- Regional Anaesthesia Techniques in Liver and Kidney Transplantation: A Narrative Review in Donors and Recipients.Turkish journal of anaesthesiology and reanimation · 2026Article
- Association Between Cirrhosis and Acute or Severe Limb Ischemic Events Among Hospitalizations with Peripheral Artery Disease: A National Inpatient Sample Analysis.Medicina (Kaunas, Lithuania) · 2026Article
- Viscoelastic testing: Transforming hemostasis management in patients in the medical intensive care unit.World journal of critical care medicine · 2026Review
- Viscoelastic haemostatic assays in chronic liver disease-Profiling coagulation in the emergency department.Vox sanguinis · 2026Article
- When Atrial Fibrillation Meets Alcoholic Liver Cirrhosis: Can Direct Oral Anticoagulants Bridge the Therapeutic Gap?Biomedicines · 2026Review
- Echocardiographic Guidance for Percutaneous Left Atrial Appendage Occlusion: A Systematic Review of Outcomes in High-Risk Populations Including Chronic Liver Disease and Prior Gastrointestinal Bleeding.Diagnostics (Basel, Switzerland) · 2026Review
- Diagnostic Performance of Prothrombin Time and Activated Partial Thromboplastin Time in Children: A Service Evaluation.International journal of laboratory hematology · 2026Article
- Mechanistic insights into the liver-brain axis during chronic liver disease.Nature reviews. Gastroenterology & hepatology · 2026Review
- ROTEM-detected hypocoagulability is associated with major non-portal hypertensive bleeding in cirrhosis.Hepatology communications · 2026Article
- Coagulation Abnormalities in Liver Cirrhosis: Diagnostic and Therapeutic Approaches.Medicina (Kaunas, Lithuania) · 2026Review
- Development and internal validation of a nomogram for early prediction of deep vein thrombosis after liver transplantation: an exploratory machine-learning comparison.Frontiers in medicine · 2026Article
- Total thrombus formation system exploration of primary hemostasis in cirrhotic patients.Research and practice in thrombosis and haemostasis · 2026Article
- Direct oral anticoagulants in patients with advanced cirrhosis: is it time?Research and practice in thrombosis and haemostasis · 2026Article
- Thrombin dynamics and clinical events in cirrhosis: low prothrombin conversion predicts bleeding risk.Frontiers in cell and developmental biology · 2026Article
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 7 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Patients with liver diseases acquire complex alterations in their hemostatic system that may lead to abnormalities in routine diagnostic test of hemostasis. Thrombocytopenia, prolongations in the prothrombin time and activated partial thromboplastin time, and decreased plasma fibrinogen are common in patients with advanced liver disease. Historically, liver diseases therefore have been classified as an acquired bleeding disorder. Laboratory and clinical observations have demonstrated that although routine diagnostic tests of hemostasis suggest a hypocoagulable state, patients with liver disease also tend to develop thrombotic events. Overall, patients have commensurate changes in both pro- and antihemostatic pathways. This new hemostatic balance, however, appears much more fragile than the hemostatic balance in individuals with normal liver function, and patients with liver disease can readily experience both hemostasis-related bleeding and thrombotic events. These insights into the hemostatic balance in patients with liver disease have led to revised recommendations for clinical management of hemostasis. In 2020, an SSC working group within the ISTH has been founded with the aim to disseminate new concepts on prevention and treatment of bleeding and thrombosis in patients with liver disease. The current document will outline the hemostatic changes in patients with liver disease, the limitations of routine diagnostic tests of hemostasis, and the concept of rebalanced hemostasis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.