THE THERAPEUTIC APPROACH TO DEEP VENOUS THROMBOSIS IN THE PATIENT WITH CIRRHOSIS OF THE LIVER
THE THERAPEUTIC APPROACH TO DEEP VENOUS THROMBOSIS IN THE PATIENT WITH CIRRHOSIS OF THE LIVER (Abstract): Venous thromboembolism is considered a very rare event in patients with liver cirrhosis, thus explaining unpredictable outcome. This may be due to the severe liver disease profoundly affecting coagulation. Patients with cirrhosis also have a reduction in anticoagulant proteins so their coagulative situation is characterized by a new balance of pro- and anticoagulation factors, defined as “rebalanced hemostasis”. Starting from the existing data in the literature so far, we studied 8 male patients previously known with cirrhosis, who were hospitalized with deep vein thrombosis (DVT) in the lower limbs in the Cardiology Clinic. The therapeutic approach to deep venous thrombosis associated with liver cirrhosis raises some issues related to the particular bleeding risk in this category of patients. DVT is not a rare condition in cirrhosis. The diagnosis of liver cirrhosis had been previously confirmed and justified by the presence of medical records at admission, and the diagnosis of DVT was based on clinical symptoms of DVT and confirmed using Duplex Doppler ultrasonography criteria for DVT. Viral etiology of cirrhosis was predominant and diabetes mellitus was the only variable that was significantly associated with the presence of DVT. It is important though to consider, that serum albumin level of less than 3 mg/dL tended to be a risk factor. Our results coincide with those reported in the studied literature. The treatment unanimously accepted so far, initially with low-molecular-weight heparin (for 7-10 days) continued with Acenocumarol is adequate, with a low risk of bleeding. The precise mechanisms of hypercoagulability and thrombosis in cirrhosis are not well known and need further investigation.
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