Coagulopathies in patients with liver cirrhosis

Ciroza jetre posljednji je stadij kronične jetrene bolesti, a karakterizirana je difuznim, ireverzibilnim fibroznim promjenama jetrenog parenhima. Glavni uzroci su pretjerana konzumacija alkohola i kronična infekcija virusom hepatitisa B ili C. Jetra ima mnogobrojne uloge u metabolizmu i pohrani tvari, stoga su znakovi i simptomi oštećenja jetrene funkcije raznoliki i brojni: umor, žutica, ascites, edemi, splenomegalija, varikoziteti jednjaka itd.. Jetra ima važnu ulogu u sintezi prokoagulacijskih i antikoagulacijskih tvari pa poremećaji jetrene funkcije dovode do abnormalnosti procesa hemostaze. Hemostaza se može podijeliti u četiri faze: vazospazam i stvaranje trombocitnog čepa, koagulacijska kaskada, zaustavljanje zgrušavanja i fibrinoliza. U cirozi jetre prisutni su poremećaji trombocita u smislu trombocitopenije i smanjene funkcije. Nedostatna je sinteza faktora koagulacije, ali i antikoagulacijskih proteina. Portalna hipertenzija i disfunkcija endotela također imaju ulogu u poremećaju hemostaze. Rezultat ovih promjena je povećan rizik i krvarenja i tromboze. Standardni testovi za procjenu poremećaja koagulacije ne mogu otkriti sve poremećaje hemostaze, a rezultati pretraga ne koreliraju uvijek s kliničkim stanjem, što predstavlja dodatni problem u dijagnostičkom i terapijskom pristupu.Liver cirrhosis is an end-stage liver disease, characterised by diffuse, irreversible fibrous changes of the liver parenchyma. The main causes are long-term alcohol abuse as well as hepatitis B and hepatitis C infections. Considering the function of the liver as the main metabolic organ, the signs and symptoms of liver failure due to cirrhosis are numerous. Some of them are fatigue, jaundice, ascites, oedema, splenomegaly and varices. The liver has an important role in the synthesis of both coagulation and anticoagulation proteins, therefore decreased liver function leads to abnormal haemostasis. Haemostasis can be divided into four phases – vasospasm and platelet plug formation, coagulation cascade, clotting process termination (antithrombotic mechanism) and fibrinolysis. In liver cirrhosis, there are platelet abnormalities such as thrombocytopenia and decreased platelet function. The synthesis of proteins important in coagulation and fibrinolysis is decreased. Portal hypertension and endothelial dysfunction also play a role in abnormal coagulation. The result is an increased risk for bleeding and thrombotic incidents. Traditional coagulation tests may not be reliable for assessing bleeding and thrombotic risk, and the results of these tests do not always corelate with the patient's condition. That presents an additional problem in the diagnostic and therapeutic approach