Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease DOI Creative Commons
Lidia Canillas,

Amalia Pelegrina,

Juan G. Álvarez

et al.

Life, Journal Year: 2023, Volume and Issue: 13(1), P. 132 - 132

Published: Jan. 3, 2023

(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer more comorbidities because of improved medical and surgical management. However, patients ACLD at increased risk perioperative morbidity mortality; (2) Methods: We conducted a comprehensive review the literature to support narrative clinical guideline about assessment mortality management in undergoing procedures; (3) Results: Slight data exist guide ACLD, most recommendations based on case series expert opinion. The severity dysfunction, portal hypertension, cardiopulmonary renal comorbidities, complexity surgery type (elective versus emergent) predictors mortality. Expert multidisciplinary teams necessary evaluate manage before, during, after (4) Conclusions: This practice document updates available optimize who undergo procedures.

Language: Английский

Diagnosis and Management of Esophagogastric Varices DOI Creative Commons

Socrate Pallio,

G Melita, Endrit Shahini

et al.

Diagnostics, Journal Year: 2023, Volume and Issue: 13(6), P. 1031 - 1031

Published: March 8, 2023

Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and one the most common causes acute upper gastrointestinal bleeding. Thus, esophagogastric varices represent major economic population health issue. Patients with advanced chronic liver disease typically undergo an endoscopy to screen for varices. However, not recommended patients stiffness < 20 KPa platelet count > 150 × 109/L as there low probability high-risk should receive primary prophylaxis either nonselective beta-blockers or endoscopic band ligation. In cases AVB, within 12 h after resuscitation hemodynamic stability, whereas be performed soon possible if are unstable. suspected bleeding, starting vasoactive therapy in combination treatment recommended. On other hand, uncontrolled balloon tamponade self-expandable metal stents can used bridge more definitive such transjugular intrahepatic portosystemic shunt. This article aims offer comprehensive review recommendations from international guidelines well recent updates on management

Language: Английский

Citations

25
Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV) DOI Creative Commons
Mattias Mandorfer, Elmar Aigner,

Manfred Cejna

et al.

Wiener klinische Wochenschrift, Journal Year: 2023, Volume and Issue: 135(S3), P. 493 - 523

Published: June 26, 2023

The Billroth IV consensus was developed during a meeting of the Austrian Society Gastroenterology and Hepatology (ÖGGH) Interventional Radiology (ÖGIR) held on 26th November 2022 in Vienna.Based international recommendations considering recent landmark studies, provides guidance regarding diagnosis management portal hypertension advanced chronic liver disease.

Language: Английский

Citations

23
Anticoagulation for stroke prevention in atrial fibrillation and treatment of venous thromboembolism and portal vein thrombosis in cirrhosis: guidance from the SSC of the ISTH DOI Creative Commons
Stephanie Carlin, Adam Cuker, A. Gatt

et al.

Journal of Thrombosis and Haemostasis, Journal Year: 2024, Volume and Issue: 22(9), P. 2653 - 2669

Published: May 31, 2024

While advanced liver disease was previously considered to be an acquired bleeding disorder, there is increasing recognition of associated prothrombotic state with patients being at higher risk atrial fibrillation (AF) and stroke venous thromboembolism (VTE) including portal vein thrombosis (PVT). We review the available literature on epidemiology, pathophysiology, factors provide guidance anticoagulant management these conditions in adults cirrhosis. In Child-Pugh A or B cirrhosis AF, we recommend anticoagulation standard-dose direct oral anticoagulants (DOACs) accordance cardiology guideline recommendations for without disease. those C cirrhosis, inadequate evidence respect benefit prevention AF. acute deep pulmonary embolism, suggest use either a DOAC low-molecular-weight heparin (LMWH)/vitamin K antagonist (VKA) LMWH alone (or as bridge VKA normal baseline international normalized ratio) symptomatic PVT. asymptomatic, progressing PVT continuing extended transplant candidates

Language: Английский

Citations

14
CiThroModel Improves Prediction of Symptomatic Venous Thromboembolism in Hospitalized Patients With Cirrhosis Without Hepatocellular Carcinoma DOI Creative Commons
Alberto Zanetto, Alessandro Vitale, Filippo Pelizzaro

et al.

United European Gastroenterology Journal, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 23, 2025

Venous thromboembolism (VTE) is a recognized complication of acutely ill patients, but its incidence and risk factors in those with cirrhosis are uncertain. We retrospectively studied consecutive cohort patients non-electively admitted to our medical unit determine the rates symptomatic VTE during hospitalization. Firstly, we explored associations baseline, clinical laboratory characteristics using logistic regression. Secondly, developed prediction model that could predict in-hospital VTE. included 687 (median age 61 years old; 68% male; Child-Pugh A/B/C, 13%/40%/47%). During hospitalization, 34 (4.9%) experienced Multivariate analysis showed male sex (OR: 2.56, p = 0.05), AKI 3.1, 0.001), bacterial infections 2.6, 0.008), Pugh score 1.6. < family history thrombosis 0.04), reduced mobility 4.6, C-reactive protein 1.1, 0.005) were independent predictors combined these variables (CirrhosisThrombosisModel) accurately discriminated between high- low-risk patients. The AUROC CiThroModel was significantly higher than Padua (0.882 vs. 0.742). After validating bootstrapping, adjusted maintained optimal discrimination ability (0.862) calibration. formula calculate -9.00 + 0.82 [Male sex] 1.14 [AKI] 0.98 [Infection] 0.48 * Child [VTE history] 1.54 [Reduced mobility] 0.15 PCR/10. seems valuable tool for identifying hospitalized at (https://majinzin.shinyapps.io/vterisk/).

Language: Английский

Citations

1
Redefining haemostasis: Role of rotational thromboelastometry in critical care settings DOI

Sahil Kataria,

Deven Juneja,

Omender Singh

et al.

World Journal of Critical Care Medicine, Journal Year: 2025, Volume and Issue: 14(2)

Published: Feb. 27, 2025

Management of patients with acute hemorrhage requires addressing the source bleeding, replenishing blood volume, and any coagulopathy that may be present. Assessing predicting requirements in real-time experiencing ongoing bleeding can pose substantial challenges. In these patients, transfusion concepts based on ratios do not effectively address or reduce mortality. Moreover, ratio-based stop bleeding; instead, they just give physicians more time to identify plan management strategies. clinical practice, standard laboratory coagulation tests (SLCT) are frequently used assess various aspects clotting. However, always offer a comprehensive understanding clinically significant severity loss. Furthermore, SLCT have considerable turnaround time, which ideal for making prompt decisions. recent years, there has been growing interest point-of-care viscoelastic assays like rotational thromboelastometry, provide real-time, dynamic information about clot formation dissolution.

Language: Английский

Citations

1
Thromboprophylaxis for venous thromboembolism prevention in hospitalized patients with cirrhosis: Guidance from the SSC of the ISTH DOI Creative Commons
Lara N. Roberts, Virginia Hernández‐Gea, Maria Magnusson

et al.

Journal of Thrombosis and Haemostasis, Journal Year: 2022, Volume and Issue: 20(10), P. 2237 - 2245

Published: July 25, 2022

Language: Английский

Citations

30
Intensive care management of acute-on-chronic liver failure DOI
Giovanni Perricone, Thierry Artzner, Eléonora De Martin

et al.

Intensive Care Medicine, Journal Year: 2023, Volume and Issue: 49(8), P. 903 - 921

Published: Aug. 1, 2023

Language: Английский

Citations

20
Portal vein thrombosis in cirrhosis: A literature review DOI Creative Commons
Swathi Prakash,

Jared Bies,

Mariam Hassan

et al.

Frontiers in Medicine, Journal Year: 2023, Volume and Issue: 10

Published: April 26, 2023

Portal Vein Thrombosis (PVT), a common complication of advanced liver disease, is defined as an obstruction the portal vein due to thrombus formation that can extend superior mesenteric and splenic veins. It was believed PVT occurred predominantly prothrombotic potential. However, recent studies have shown decreased blood flow related hypertension appears increase risk per Virchow's triad. well known there higher incidence PVTs in cirrhosis with MELD Child Pugh score. The controversy for management cirrhotics lies individualized assessment risks versus benefits anticoagulation, since these patients complex hemostatic profile both bleeding procoagulant propensities. In this review, we will systematically compile etiology, pathophysiology, clinical features, thrombosis cirrhosis.

Language: Английский

Citations

17
Expert opinion on bleeding risk from invasive procedures in cirrhosis DOI Creative Commons
Alix Riescher‐Tuczkiewicz, Stephen H. Caldwell, Patrick S. Kamath

et al.

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.

Language: Английский

Citations

17
Management of coagulopathy among patients with cirrhosis undergoing upper endoscopy and paracentesis: Persistent gaps and areas of consensus in a multispecialty Delphi DOI Open Access
Elliot B. Tapper, Matthew A. Warner, Rajesh P. Shah

et al.

Hepatology, Journal Year: 2024, Volume and Issue: 80(2), P. 488 - 499

Published: April 1, 2024

Patients with cirrhosis have abnormal coagulation indices such as a high international normalized ratio and low platelet count, but these do not correlate well periprocedural bleeding risk. We sought to develop consensus among the multiple stakeholders in care inform process measures that can help improve quality of management coagulopathy cirrhosis. identified candidate for contexts relating performance paracentesis upper endoscopy. An 11-member panel content expertise was convened. It included nominees from professional societies interventional radiology, transfusion medicine, anesthesia representatives hematology, emergency transplant surgery, community practice. Each measure evaluated agreement using modified Delphi approach (3 rounds rating) define final set measures. Out 286 possible measures, 33 made set. International testing required diagnostic or therapeutic Plasma should be avoided all paracenteses No achieved items intent emergent The risks prophylactic transfusions exceed their benefits outpatient endosopies. For other procedures examined, outweigh when count is >20,000/mm 3 . uncertain whether below 20,000/mm contexts. on it permissible continue stop systemic anticoagulation. Continuous aspirin each procedure. Clopidogrel found many areas may serve foundation common practice metrics

Language: Английский

Citations

7