Diagnosis:
Coagulopathy of liver disease.
• The liver is the major site of synthesis of both procoagulant and anticoagulant proteins.
• The procoagulant factors produced by the liver include factors II, VII, IX, X, XI, XII, V, and VIII, plasminogen activator inhibitor 1 (PAI-I), α2-antiplasmin, and thrombin activatable fibrinolysis inhibitor (TAFI).
• The anticoagulant factors produced by the liver include antithrombin (AT), protein C (PC), protein S (PS), tissue factor pathway inhibitor (TFPI), and plasminogen.
• Factor V, factor VIII, PAI-1, AT, PC, PS, and TFPI are also synthesized by extrahepatic sites.
• Hemostatic changes found in liver disease lead to rebalancing of the coagulation system; reduction of procoagulant and fibrinolytic factors is offset by a concomitant decrease of anticoagulant and antifibrinolytic proteins.
• Patients with liver disease therefore may be at risk for both bleeding and thrombotic complications.
Roberts LN, Patel RK, Arya Y:
Haemostasis and thrombosis in liver disease. Br J Haematol 2009;148:507–521.
