Hämostaseologie,
Journal Year:
2025,
Volume and Issue:
45(01), P. 024 - 048
Published: Feb. 1, 2025
Abstract
In
this
review,
we
aim
to
highlight
the
extent
of
inappropriate
hemostasis
testing
and
provide
practical
guidance
on
how
prevent
it.
We
will
focus
acute
setting,
including
but
not
limited
emergency
department
intensive
care
unit.
To
end,
first
discuss
significance
inappropriateness,
in
general
context
laboratory
medicine.
This
includes
acknowledging
importance
phenomenon
attempting
define
Next,
describe
harmful
consequences
testing.
Finally,
use
setting.
The
second
section
describes
interventions―in
particular,
implementation
for
testing—can
efficiently
reduce
inappropriateness.
third
section,
summarize
available
recommendations
rational
(platelet
count,
activated
partial
thromboplastin
time,
prothrombin
time/international
normalized
ratio,
fibrinogen,
thrombin
D-dimer,
anti-Xa
assay,
antithrombin,
ADAMTS13
activity,
antiheparin-PF4
antibodies,
viscoelastometric
tests,
coagulation
factors,
platelet
function
testing),
as
supported
by
guidelines,
recommendations,
and/or
expert
opinions.
Overall,
review
is
intended
be
a
toolkit
effort
promote
appropriate
Hopefully,
new
Vitro
Diagnostic
Medical
Device
Regulation
(EU)
2017/746
(IVDR)
should
help
improving
availability
evidence
regarding
clinical
performance
assays.
Frontiers in Immunology,
Journal Year:
2023,
Volume and Issue:
14
Published: Dec. 5, 2023
During
fibrosis,
(myo)fibroblasts
deposit
large
amounts
of
extracellular
matrix
proteins,
thereby
replacing
healthy
functional
tissue.
In
liver
this
leads
to
the
loss
hepatocyte
function,
portal
hypertension,
variceal
bleeding,
and
increased
susceptibility
infection.
At
an
early
stage,
fibrosis
is
a
dynamic
reversible
process,
however,
from
cirrhotic
there
significant
progression
hepatocellular
carcinoma.
Both
liver-resident
macrophages
(Kupffer
cells)
monocyte-derived
are
important
drivers
progression,
but
can
also
induce
its
regression
once
triggers
chronic
inflammation
eliminated.
cancer,
they
attracted
tumor
site
become
tumor-associated
(TAMs)
polarized
towards
M2-
anti-inflammatory/tumor-promoting
phenotype.
Besides
their
role
in
thrombosis
hemostasis,
platelets
stimulate
development
by
secreting
profibrogenic
factors
regulating
innate
immune
response,
e.g.,
interacting
with
monocytes
macrophages.
Here,
we
review
recent
literature
on
interplay
JHEP Reports,
Journal Year:
2023,
Volume and Issue:
6(3), P. 100986 - 100986
Published: Dec. 19, 2023
Despite
several
recent
international
guidelines,
no
consensus
exists
on
the
bleeding
risk
nor
haemostatic
parameter
thresholds
that
define
safety
of
invasive
procedures
in
patients
with
cirrhosis.
The
aim
this
study
was
to
establish
a
position
paper
associated
cirrhosis
among
experts
involved
various
guidelines.
World Journal of Hepatology,
Journal Year:
2024,
Volume and Issue:
16(9), P. 1229 - 1246
Published: Sept. 23, 2024
Hematological
abnormalities
are
common
in
cirrhosis
and
associated
with
various
pathophysiological
mechanisms.
Studies
have
documented
a
prevalence
of
thrombocytopenia,
leukopenia,
anemia
patients
compensated
77.9%,
23.5%,
21.1%,
respectively.
These
carry
significant
clinical
implications,
including
considerations
for
invasive
procedures,
infection
risk,
bleeding
prognosis.
Previously,
was
believed
to
predispose
due
alterations
observed
classical
coagulation
tests
such
as
prothrombin
time,
partial
thromboplastin
international
normalized
ratio,
thrombocytopenia.
However,
this
understanding
has
evolved,
now
also
acknowledged
being
at
high
risk
thrombotic
events.
Hemostasis
presents
complex
phenotype,
procoagulant
anticoagulant
offsetting
each
other.
This
multifactorial
phenomenon
is
inadequately
reflected
by
routine
laboratory
tests.
Thrombotic
complications
more
prevalent
decompensated
may
correlate
disease
severity.
Bleeding
primarily
portal
hypertension,
endothelial
dysfunction,
mechanical
vessel
injury,
disseminated
intravascular
coagulation,
endotoxemia,
renal
injury.
review
comprehensively
outlines
hematologic
index
abnormalities,
mechanisms
hemostasis,
fibrinolysis
limitations
testing,
manifestations
thrombosis
liver
cirrhosis.
JHEP Reports,
Journal Year:
2024,
Volume and Issue:
6(6), P. 101051 - 101051
Published: Feb. 28, 2024
Major
bleeding
events
during
orthotopic
liver
transplantation
(OLT)
are
associated
with
poor
outcomes.
The
proportion
of
this
risk
related
to
portal
hypertension
is
unclear.
Hepatic
venous
pressure
gradient
(HVPG)
the
gold
standard
for
estimating
hypertension.
aim
study
was
analyze
ability
HVPG
predict
intraoperative
major
OLT
in
patients
cirrhosis.
Pharmaceuticals,
Journal Year:
2025,
Volume and Issue:
18(3), P. 339 - 339
Published: Feb. 27, 2025
Ascites
is
the
most
common
complication
from
cirrhosis
related
to
portal
hypertension
and
depicts
onset
of
hepatic
decompensation.
Ranging
uncomplicated
refractory
ascites,
progression
carries
prognostic
value
by
reflecting
deterioration
underlying
hypertension.
Diuretics
have
been
mainstay
treatment
control
but
side
effects
heighten
when
dosage
escalated.
Non-selective
beta-blockers
(NSBBs)
are
widely
used
nowadays
prevent
decompensation
variceal
hemorrhage.
However,
with
worsening
systemic
vasodilation
inflammation
ascites
progresses,
patients
on
NSBBs
at
risk
hemodynamic
collapse
leading
renal
hypoperfusion
thus
hepatorenal
syndrome.
Long-term
albumin
infusion
was
studied
ascites.
results
were
conflicting.
Sodium-glucose
cotransporter-2
inhibitors
under
investigation
With
that,
may
require
regular
large-volume
paracentesis.
an
aging
population,
more
put
anti-thrombotic
agents
their
risks
in
decompensated
invasive
procedures
be
considered.
In
general,
poses
multiple
issues
pharmacological
treatment.
present
review,
we
discuss
challenges
controversies
Journal of Clinical Medicine,
Journal Year:
2025,
Volume and Issue:
14(9), P. 2914 - 2914
Published: April 23, 2025
Direct
oral
anticoagulants
(DOACs)
have
emerged
as
a
preferred
alternative
to
vitamin
K
antagonists
(VKAs)
for
the
prevention
and
treatment
of
thromboembolic
disorders,
offering
improved
safety,
predictable
pharmacokinetics,
ease
administration.
Despite
these
advantages,
their
use
in
complex
clinical
scenarios
presents
significant
challenges
that
necessitate
individualized
therapeutic
strategies.
This
comprehensive
review
explores
efficacy,
limitations
DOAC
therapy
special
populations,
including
patients
with
renal
or
hepatic
impairment,
obesity,
cancer-associated
thrombosis,
antiphospholipid
syndrome.
Additionally,
we
examine
role
uncommon
thrombotic
conditions
such
superficial
venous
embolic
stroke
undetermined
source,
upper
extremity
vein
inferior
vena
cava
pelvic
cerebral
thrombosis.
The
pharmacokinetic
variability
DOACs
dysfunction
requires
caution
balance
bleeding
risks.
In
altered
drug
distribution
metabolism
raise
concerns
regarding
appropriate
dosing
efficacy.
Cancer-associated
thrombosis
interplay
prothrombotic
mechanisms,
necessitating
careful
selection
anticoagulant
therapy.
Furthermore,
syndrome
remains
controversial
due
about
recurrent
events.
Finally,
some
unusual
like
cava,
vein,
has
scarce
evidence.
aims
guide
clinicians
optimizing
anticoagulation
management
challenging
patient
populations
by
synthesizing
current
evidence
providing
practical
recommendations.
