1,721,117 research outputs found
Squilibrio emostatico nei pazienti con cirrosi: il ruolo di insufficienza renale acuta ed epatocarcinoma
No full textI pazienti con cirrosi hanno profonde alterazioni dell’emostasi. Queste alterazioni includono ridotta conta piastrinica ed incremento del fattore di Von Willebrand, ridotti livelli di fattori pro ed anticoagulanti, e alterazioni della fibrinolisi.
Ne deriva che l’equilibrio emostatico nei pazienti con cirrosi è fragile e suscettibile a perturbazioni esterne che possono spingerlo verso l’ipo-coagulabilità (aumentato rischio di emorragia) o l’iper-coagulabilità (aumentato rischio di trombosi).
Valutare le alterazioni dell’emostasi associate alla cirrosi e alle sue complicanze potrebbe migliorare la gestione delle complicanze emorragiche e trombotiche in questi pazienti.
In questa studio, abbiamo valutato le alterazioni emostatiche indotte da due frequenti complicazioni associate alla cirrosi: l’insufficienza renale acuta e l'epatocarcinoma.
Nella prima parte dello studio, abbiamo dimostrato che l’insufficienza renale acuta è associata a complesse alterazioni emostatiche sia in senso pro-emorragico (disfunzione piastrinica, ridotto livello di FXIII, e iper-fibrinolisi) sia pro-trombotiche (aumentato livello di FVIII, ridotti anticoagulanti, e ipo-fibrinolisi). Questi dati supportano l’associazione fra insufficienza renale acuta e rischio di emoperitoneo post-paracentesi nei pazienti con cirrosi scompensata, e rinforzano la necessità di trattamento proattivo dell’insufficienza renale acuta nei pazienti con cirrosi sottoposti a procedure invasive. Infatti, il miglioramento della funzione renale potrebbe ridurre i rischi di emorragia e trombosi.
Nella seconda parte della tesi, abbiamo dimostrato che l’epatocarcinoma nei pazienti con cirrosi è associato ad un più significativo stato iper-coagulabile dovuto ad aumentata aggregazione piastrinica, attivazione della coagulazione e iper-coagulabilità plasmatica, e ridotta attivazione della fibrinolisi. Questi cambiamenti iper-coagulabili supportano l’associazione tra epatocarcinoma e aumentato rischio di trombosi venosa portale nei pazienti con cirrosi ed epatocarcinoma, e rinforzano la necessità di studi clinici per valutare l'eventuale utilizzo di terapia anticoagulante profilattica per prevenire la comparsa di complicanze trombotiche in questi pazienti.Patients with cirrhosis have profound alterations of hemostasis that include thrombocytopenia and increased level of Von Willebrand factor, reduced levels of most procoagulant factors and inhibitors, and complex changes in fibrinolysis.
Current theory posits that these changes result in a rebalanced hemostatic state that is maintained by a simultaneous decline in both pro and anti-hemostatic drivers. This equilibrium, however, becomes susceptible to perturbations and easily shifts towards either hypo-coagulability (increased risk of bleeding) or hyper-coagulability (increased risk of thrombosis).
Understanding the hemostatic alterations associated with cirrhosis and its complications would improve the management of bleeding and thrombosis in these patients.
In this two-part project, we extensively investigated alterations of hemostasis driven by two common complications observed in patients with cirrhosis, that is acute kidney injury (AKI) and hepatocellular carcinoma (HCC).
In study part #1, we demonstrated that AKI is associated with complex hemostatic changes including both prohemorrhagic and prothrombotic features. On one hand, AKI was associated with platelet dysfunction, low FXIII, and hyper-fibrinolytic alterations (increased bleeding tendency), while on the other hand AKI was associated with increased FVIII, reduced anticoagulants, and hypo-fibrinolytic defects (increased thrombotic tendency). These data support the association between AKI and post-paracentesis hemoperitoneum seen in patients with decompensated cirrhosis, and reinforce the importance of treating AKI in these patients. In fact, optimization of renal function may help to restore the hemostatic balance and mitigate bleeding and thrombotic risks.
In study part #2, we demonstrated that HCC in cirrhosis is associated with a more pronounced hypercoagulable profile due to increased platelet aggregation, activation of coagulation and plasmatic hypercoagulability, and reduced activation of fibrinolysis. These hypercoagulable changes provide explanation for the increased risk of portal vein thrombosis in patients with cirrhosis and HCC, and reinforce the need for studies on prophylactic anticoagulation for the prevention of thrombotic complications in these patients
Frailty and Sarcopenia in Cirrhosis: Current Knowledge and Future Directions
Full text linkPurpose of the review: This narrative review aims to update current knowledge about frailty, sarcopenia, and their interplay, highlight gaps in the literature. Recent findings: Sarcopenia involves loss of skeletal muscle mass, while frailty reflects broader functional decline, including muscle strength impairment. These conditions are interrelated, but distinct and poor correlation between them has been reported. Research on sarcopenia and frailty in acute-on-chronic liver failure (ACLF) and hepatocellular carcinoma (HCC) highlights their prognostic significance, though findings are heterogeneous. Sex oriented analysis is needed to clarify different impacts on outcome. Summary: End-stage liver disease increases the risk of sarcopenia and frailty particularly in advanced cases. CT-based skeletal muscle index is the gold standard for sarcopenia diagnosis, while ultrasound offers potential for outpatient use. Frailty is increasingly recognized as a critical predictor of survival both pre-..
Filling the gap between clinical trials and real life in the treatment of severe HCV recurrence after liver transplantation
Full text linkSome Answers and More Questions About Portal Vein Thrombosis in Patients With Decompensated Cirrhosis
No full textManagement of acute variceal hemorrhage
Full text linkGastrointestinal bleeding is one of the major causes of death in patients with cirrhosis, and gastroesophageal varices represent the main source of hemorrhage. Even though in the last decades survival has been improved because of the widespread adoption of effective treatments and optimization of general medical care, mortality is still significantly high, and decompensated patients pose a complex challenge requiring a multidisciplinary approach that is crucial to improve survival. The aims of this commentary are to review the most recent advances in the management of esophageal variceal bleeding and to highlight useful information to aid hepatologists in clinical practice
Beyond the hype: understanding the limits of perceived benefits in endoscopic ultrasound-guided portal pressure gradient measurement
No full textHepatitis B and liver transplantation
No full textLiver transplantation (LT) is the only effective treatment for hepatitis B-virus (HBV) related end stage liver disease, even if the outcome of these patients, has significantly improved after introduction of effective and well tolerated nucleos/tide analogues (NUC). Pre-transplant therapy has been initially based on lamivudine, but entecavir and tenofovir represent the currently recommended first-line therapeutic option in patients with HBV decompensated cirrhosis. After LT, the development of hepatitis B immunoglobulin (HBIG) in the early 1990s change dramatically the prognosis of these patients by reducing the incidence of HBV recurrence and increasing survival rate. Combination of HBIG and NUC is now considered as the standard of care for prophylaxis against HBV recurrence, however personalized therapeutic algorithms based on pre and post-transplant viral and host factors have been proposed. Finally, liver grafts from hepatitis B core antibody (anti-HBc) positive donors and from hepatitis B antigens (HBsAg) positive donors can be safely used in selected patients
COVID-19 and liver disease: where are we now?
No full textPatients with end-stage liver disease and COVID-19 are at a higher risk of hospitalization, ventilation and death than those without chronic liver disease. Whether the aetiology of liver disease also affects the natural history of COVID-19 in cirrhosis is debated. Effective and universal vaccination is paramount to combat SARS-CoV-2 infection
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