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. 2015 Jul 8;7(13):1730-4.
doi: 10.4254/wjh.v7.i13.1730.

Changing common sense: Anti-platelet/coagulation therapy against cirrhosis

Yoshihiro Ikura  1 , Tatsuya Osuga  1
Affiliations

Changing common sense: Anti-platelet/coagulation therapy against cirrhosis

Yoshihiro Ikura et al. World J Hepatol. .

Abstract

Until recently, anti-platelet/coagulation therapy had not been recommended for patients with cirrhosis. Although venous thrombosis is one of the representative complications of cirrhosis and ischemic disorders associated with atherosclerosis are not infrequent in cirrhotic patients, many clinicians have tended to hesitate to introduce anti-platelet/coagulation therapy to their patients. Undoubtedly, this is due to the increased risk of hemorrhagic diathesis in cirrhotic patients. However, accumulating evidence has revealed the benefits of anti-platelet/coagulation therapy for cirrhotic patients. In addition to the safety of the therapy carried out against cardiovascular diseases in cirrhotic patients, some clinical data have indicated its preventive effect on venous thrombosis. Moreover, the efficacy of anti-platelet/coagulation therapy against cirrhosis itself has been demonstrated both clinically and experimentally. The conceptual basis for application of anti-platelet/coagulation therapy against cirrhosis was constructed through two pathologic studies on intrahepatic thrombosis in cirrhotic livers. It may be better to use thrombopoietin-receptor agonists, which have been tested as a treatment for cirrhosis-related thrombocytopenia, in combination with anti-platelet drugs to reduce the risk of venous thrombosis. During the last decade, the World Journal of Gastroenterology, a sister journal of World Journal of Hepatology, has been one of the main platforms of active discussion of this theme.

Keywords: Anti-platelet/coagulation therapy; Cirrhosis; Hemorrhagic diathesis; Thrombocytopenia; Thrombosis.

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Figures

Figure 1
Figure 1
Theoretically ideal therapies against cirrhosis-related thrombocytopenia depending on the etiology. The platelet count in cirrhotics is determined mainly by three major factors, including (A) a rate of thrombopoiesis, (B) the presence/abscence of hypersplenism, and (C) the presence/abscence of thrombotic diathesis, which differently affect each case. Patients with thrombocytopenic conditions A, B, or C are considered to respond well to thrombopoietin receptor agonists, splenectomy, and anti-platelet/coagulation drugs, respectively. In patients with condition D, a combination of thrombopoietin receptor agonists and anti-platelet/coagulation drugs is thought to be necessary.
Figure 2
Figure 2
Platelet aggregation in a cirrhotic liver. A: Immunohistochemical findings. Platelets are stained in brown. (Immunoperoxidase for CD41; original magnification, × 400); B: The corresponding histological findings. Platelets cannot be identified in this photomicrograph. (Hematoxylin-eosin; original magnification, × 400).
See this image and copyright information in PMC

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