Effects of interventions on hemostatic status in liver disease
Research type
Research Study
Full title
Effects of interventions on hemostatic status in liver disease
IRAS ID
259126
Contact name
William Bernal
Contact email
Sponsor organisation
Kings College Hospital NHS Foundation Trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Summary of Research
The liver plays a fundamental role in the process of blood coagulation (hemostasis), not only because it synthesizes the majority of the pro- and anti-hemostatic factors in the circulation, but also because of its role in their clearance from the circulation.
Patients with liver disease have complex changes in this system that seem to result in a ‘rebalanced’, yet unstable pattern of hemostasis. There is now evidence that patients with liver disease are at increased risk for both clotting (thrombotic) and bleeding (hemorrhagic) complications. Guidelines on the clinical use of pro- and anti-hemostatic therapies are derived from research in patients with intact liver function and little is known about how these should be used in patients with liver disease.
Our recent laboratory-based studies have indicated that the potency of commonly used pro- and anti-hemostatic interventions in patients with cirrhosis is substantially altered as compared to patients with intact liver function. This likely results in part from the complex effects of the rebalancing of hemostatic factors synthesised by the liver and alterations in vivo clearance of these drugs. Importantly, there is also emerging evidence that many of the interventions currently utilised to address coagulation abnormalities in patients with liver disease may either be ineffective or potentially harmful.
There is thus an important need to develop an understanding of the effects of these interventions in practice, to enable a more evidence-based management of disordered coagulation in patients with liver disease. The objective of this study therefore is to compare the effects of pro- and anti-hemostatic interventions on hemostatic status of patients with cirrhosis to that in patients with intact liver function in a ‘real-world’ clinical setting.Summary of Results
We studied the effects on functional tests of blood clotting of different forms to medication given to people with liver disease as part of their use care whilst in hospital. We found that heparin treatment had similar effects to those in people who didn't have liver problems, so no major changes in doses are usually required (doi/10.1111/jth.15296). We also found that treatment with fresh plasma or platelets had only a modest effect - and often wouldn't be of benefit (DOI: 10.1111/jth.15185 ). We hope that these results will help us decide on the best forms of treatment through providing an evidence base to guide care.REC name
Wales REC 7
REC reference
19/WA/0168
Date of REC Opinion
24 May 2019
REC opinion
Favourable Opinion