Selecting anticoagulant therapy in patients with cirrhosis
DOI: 10.32364/2587-6821-2022-6-5-286-292
N.G. Arykan1, A.E. Shestopalov2–4, E.E. Khvorostinina1, L.A. Komarova1, A.O. Alekseeva5, K.S. Asaturyan1
1F.I. Inozemtsev City Clinical Hospital, Moscow, Russian Federation
2Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
3N.N. Burdenko Main Military Clinical Hospital, Moscow, Russian Federation
4Federal Scientific and Clinical Center for Resuscitation and Rehabilitation, Moscow, Russian Federation
5N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation
Patients with liver diseases have a higher risk of hemostatic disorders. Meanwhile, despite a well-established opinion on a low risk of thromboses in cirrhosis, thromboembolic events cannot be totally ruled out in these patients. Increased risks of thrombotic events and venous thromboembolism in cirrhosis are accounted for by external (immobilization, surgeries, infections, comorbidities) and internal factors (reduced synthesis of anticoagulants, increased levels of estrogens). Practically, the selection of anticoagulant therapy in cirrhosis is difficult because of divergent hemostatic disorders and requires continuous and careful monitoring of hemostasis. In 2019, the American Gastroenterological Association (AGA) released guidelines on anticoagulant therapy in patients with cirrhosis and pulmonary embolism. We describe a patient with cirrhosis and pulmonary embolism. A management strategy was tailored to the AGA guidelines, the Russian Society on Liver Research guid elines, and the Russian Gastroenterological Association on Fibrosis and Cirrhosis and Complication Diagnosis and Treatment guidelines. This example of successful selection of anticoagulant therapy, multidisciplinary approach, and dynamic evaluation of all available methods of hemostasis control will be useful for practitioners.
Keywords: cirrhosis, hemostasis, thrombosis, hemorrhage, venous thromboembolism, pulmonary embolism, thromboelastometry, anticoagulant, low-molecular-weight heparin.
For citation: Arykan N.G., Shestopalov A.E., Khvorostinina E.E. et al. Selecting anticoagulant therapy in patients with cirrhosis. Russian Medical Inquiry. 2022;6(5):286–292 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-286-292.
About the authors:
Nina G. Arykan — C. Sc. (Med.), anesthesiologist and intensivist of the Intensive Care Unit of the Center of Anesthesia and Resuscitation, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation; ORCID iD 0000-0002-8731-6168.
Aleksandr E. Shestopalov — Dr. Sc. (Med.), Professor, Honored Doctor of the Russian Federation, professor of the Department of Anesthesia and Emergency Medicine, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; consulting anesthesiologist and intensivist, N.N. Burdenko Main Military Clinical Hospital; 3, Gospitalnaya sq., Moscow, 105094, Russian Federation; leading researcher, Federal Scientific and Clinical Center for Resuscitation and Rehabilitation; Vice-President of the National Association of Clinical Nutrition and Metabolism; 25 build. 2, Petrovka str., Moscow, 107031, Russian Federation; ORCID iD 0000-0002-5278-7058.
Elena E. Khvorostinina — Head of the Intensive Care Unit of the Center of Anesthesia and Resuscitation, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation; ORCID iD 0000-0002-1984-0136.
Loritta A. Komarova — anesthesiologist and intensivist of the Intensive Care Unit of the Center of Anesthesia and Resuscitation, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation; ORCID iD 0000-0002-3773-7351.
Anna O. Alekseeva — resident of the Department of Anesthesia and Resuscitation, N.V. Sklifosovskiy Research Institute for Emergency Medical Aid; 3, Bolshaya Sukharevskaya sq., Moscow, 129090, Russian Federation; ORCID iD0000-0002-6488-8040.
Karen S. Asaturyan — cardiovascular surgeon, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation; ORCID iD 0000-0003-2389-058X.
Contact information: Nina G. Arykan, e-mail: md.panova@gmail.com.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 01.02.2022.
Revised 25.02.2022.
Accepted 24.03.2022.
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