Liver Cirrhosis Clinical Trial
Official title:
Risk Factors and Outcomes of Acute Venous Thromboembolism in Cirrhotic Patients: A Hospital Based Prospective Study
patient with liver cirrhosis was supposed to have autoanticoagulation which approved to be
wrong, with absence of conventional method to detect all abnormalities in coagulation state.
Thromboelastography (TEG) give a broad picture for the coagulation defects.
In addition to that no guidelines prescribed anticoagulants for venous thromboembolism in
cirrhotic, so the investigators will do a study to demonstrate frequency and risk factors for
acute venous thromboembolism in cirrhotic patients, find a conventional laboratory method and
test TEG to assess risk of thrombosis in cirrhotic patients.Also, to validate current
algorithm for use of anticoagulant and antiplatelet for thromboembolism for non cirrhotic in
cirrhotic patients.
Nowadays, the term "autoanticoagulated" ,which prescribed coagulopathy state in chronic liver
disease (CLD) patients due to impaired synthesis of coagulation factors and elevated
international normalized ratio(INR), has been approved to be wrong and those patients are
liable for venous thromboembolism (VTE) with 0.5% - 6.3% incidence of deep venous thrombosis
(DVT) and pulmonary thromboembolism (PE) among cirrhotic patients.
This may be explained by normal or even increased production of factor VIII and von
Willebrand factor, enhanced thrombin activity and Low level of protein C, protein S and
antithrombin III due to impaired liver synthesis, other risk factor include sedentary
lifestyle, fractures, immobility, hospitalization, elevated estrogen levels, surgery,
concomitant disease states and cancer, damaged vasculature that increases inflammation, and
sluggish splanchnic blood flow, which are all common in those patients.
Absence of gold standard estimation for hypercoagulability in cirrhotic patients, is a big
problem. During measurement of conventional parameters such as international normalized ratio
(INR) or partial thromboplastin time, reagents used to measure the prothrombin time do not
contain thrombomodulin on which protein C depend for activation, so it does not adequately
reflect reduced levels protein C. Thromboelastography a device that has the ability to
measure whole blood coagulation cascade including platelet function, It can be used to
monitor coagulation status before liver transplantation operation to properly identify and
treat coagulation abnormalities.
No worldwide guidelines is established neither for management nor prophylaxis of VTE in
cirrhotic patients, this may be due to safety concerns regarding the risk of bleeding related
to anticoagulant drugs when used in people with advanced liver disease, especially if there
is significant thrombocytopenia, and/or the presence of varices.
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