Venous Thromboembolism in Liver Cirrhosis: An Emerging Issue

Venous thromboembolism (VTE) carries a high morbidity and mortality and leads to a substantial economic burden. From the traditional perspectives, liver cirrhosis tends to bleeding but not VTE. However, modern concepts suggest that liver cirrhosis is also at a risk of VTE. The pooled incidence and prevalence of VTE in liver cirrhosis are 1% (95% confidence interval: 0.7–1.3%) and 1% (95% confidence interval: 0.7–1.2%), respectively. Evidence indicates that a higher international normalized ratio and a lower albumin should be associated with a higher probability of VTE in liver cirrhosis. Additionally, the presence of VTE significantly worsens the outcomes of liver cirrhosis

Alternative Diagnostic Tests of Gastroesophageal Varices in Liver Cirrhosis: Recent Advance

Routine screening for gastroesophageal varices in liver cirrhosis is necessary. At present, upper gastrointestinal endoscopy is the golden diagnostic test of gastroesophageal varices. However, the use of upper gastrointestinal endoscopy is restricted because of its poor compliance and adverse events. In this chapter, we reviewed the recent evidence regarding the value of noninvasive or less invasive tests for the diagnosis of gastroesophageal varices in liver cirrhosis

Red Blood Cell Transfusion Strategy for Upper Gastrointestinal Bleeding

Acute upper gastrointestinal bleeding (UGIB) is a potentially lethal and frequent digestive disease. It is mainly divided into the nonvariceal UGIB and variceal bleeding according to the source of bleeding. Red blood cell transfusion is the core therapeutic option for the management of acute UGIB. In this chapter, we reviewed the primary evidence from meta‐analyses and large‐scale randomized controlled trials regarding red blood cell transfusion strategy for acute UGIB

Stroke and Liver Cirrhosis: A Brief Review of Current Evidence

Stroke and liver cirrhosis are common in our everyday clinical practice, both of which can lead to serious complications. Their association is unclear. In this chapter, we briefly summarized the epidemiology of liver cirrhosis in stroke, reviewed the current evidence regarding the association between liver cirrhosis and stroke, and discussed the potential mechanisms for explaining such an association, such as coagulopathy, hypoperfusion, cardiac diseases, diabetes, and dyslipidemia

Serum Sodium Concentration in Patients with Portal Hypertension and Acute Gastrointestinal Bleeding Treated with Terlipressin: A Retrospective Observational Study

This retrospective observational study aimed to investigate the risk of serum sodium concentration in patients treated with terlipressin and attempted to explore the factors associated with serum sodium concentration. We included 17 patients with portal hypertension treated with terlipressin (Group 1), 7 with portal hypertension treated with somatostatin/octreotide (Group 2), 20 with acute non-variceal gastrointestinal bleeding treated with somatostatin/octreotide (Group 3), and 19 with acute pancreatitis treated with somatostatin/octreotide (Group 4). In all groups, serum sodium concentration at baseline was not significantly different from the lowest value during the infusion of terlipressin, somatostatin, or octreotide (Group 1: 136.95 ± 4.68 versus 135.52 ± 4.79, p = 0.426; Group 2: 139.64 ± 3.86 versus 138.41 ± 5.34, p = 0.813; Group 3: 138.02 ± 4.08 versus 137.69 ± 3.11, p = 0.630; Group 4: 135.96 ± 6.87 versus 134.60 ± 3.40, p = 0.098). The rate of serum sodium concentration reduction in Group 1 (8/17) was not significantly different from Group 2 (3/7, p = 1.000), Group 3 (11/20, p = 0.746), or Group 4 (14/19, p = 0.171). Age, sex, baseline MELD and Child-Pugh scores, cDDD value and duration of terlipressin, blood transfusion, and diuretics and paracentesis during terlipressin were not significantly associated with serum sodium concentration reduction in Group 1. In conclusion, serum sodium concentration is often reduced in patients treated with terlipressin. However, the association of sodium concentration reduction with terlipressin should be clarified

Pharmacologic Prophylaxis of Portal Venous System Thrombosis after Splenectomy: A Meta-Analysis

Portal venous system thrombosis (PVST) is a life-threatening complication of splenectomy. A meta-analysis was conducted to explore the role of pharmacologic prophylaxis of PVST after splenectomy. Overall, 359 papers were initially identified via the PubMed, EMBASE, and Cochrane Library databases. Eight of them were eligible. The incidence of PVST after splenectomy was significantly lower in patients who received the preventive measures than in those who did not (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.22–0.47, P<0.00001). Subgroup analyses demonstrated that the significant difference remained in studies including patients with portal hypertension (n=6), but not in those including patients with hematological diseases (n=2); the significant difference remained in studies using any type of prophylactic drugs (anticoagulants [n=6], thrombolytics [n=1], and prostaglandin E1 [n=1]); the significant difference remained in nonrandomized studies (n=5), but not in randomized studies (n=3). The risk of bleeding was similar between the two groups (OR: 0.65, 95% CI: 0.10–4.04, P=0.64). In conclusion, pharmacologic prophylaxis might decrease the incidence of PVST after splenectomy in patients with portal hypertension and did not increase the risk of bleeding. However, the effect of pharmacologic prophylaxis of PVST in patients with hematological diseases remained questioned