Insuficiencia hepática crónica y hemostasia

  • Christian Omar Ramos Peñafiel Hospital General de México
  • Adrian Santoyo Sánchez Hospital General de México
  • Humberto Castellanos S Hospital General de México
  • Carlos Martínez M Hospital General de México
  • Irma Olarte Hospital General de México
  • Adolfo Martínez M Hospital General de México
Palabras clave: Coagulación sanguínea, insuficiencia hepática, trombosis, vitamina K

Resumen

La insuficiencia hepática es un estado patológico que condiciona la síntesis y metabolismo de diversas biomoléculas, siendo las alteraciones a la hemostasia una de las primeras consecuencias a nivel sistémico que se hacen presentes; debido a esto y por la dimensión de los riesgos de esta situación, no es raro que las pruebas de coagulación sean indispensables para formular las escalas pronósticas en pacientes hepatópatas.

Los conocimientos sobre hemostasia han avanzado en la última década; la clásica cascada de activación de los factores de la coagulación ha sido perfeccionada hasta conformarse el ahora vigente modelo celular que considera la valiosa e indispensable participación del endotelio y las plaquetas. Gracias a esto es posible comprender que, en pacientes con insuficiencia hepática, el riesgo de sangrado no obedece únicamente a la deficiencia en la producción de los factores de la coagulación y, por tanto, es cuestionable la administración de vitamina K. Más relevante aún es que, gracias a estos conocimientos, se puede comprender el a veces contradictorio riesgo de trombosis en estos pacientes, complicación potencialmente mortal.

Descargas

La descarga de datos todavía no está disponible.

Biografía del autor/a

Christian Omar Ramos Peñafiel, Hospital General de México
Servicio de hematología
Adrian Santoyo Sánchez, Hospital General de México
Servicio de hematología
Humberto Castellanos S, Hospital General de México
Servicio de hematología
Carlos Martínez M, Hospital General de México
Servicio de hematología
Irma Olarte, Hospital General de México
Laboratorio de biología molecular
Adolfo Martínez M, Hospital General de México
Laboratorio de biología molecular

Referencias bibliográficas

Bernal W, Jalan R, Quaglia A, Simpson K, Wendon J, Burroughs A. Acute-on-chronic liver failure. Lancet 2015;386:1576–87.

https://doi.org/10.1016/S0140-6736(15)00309-8

Wang Q, Yang F, Miao Q, Krawitt EL, Gershwin ME, Ma X. The clinical phenotypes of autoimmune hepatitis: A comprehensive review. J Autoimmun 2016;66:98–107.

https://doi.org/10.1016/j.jaut.2015.10.006

Licata A. Adverse drug reactions and organ damage: The liver. Eur J Intern Med 2016;28:9–16.

https://doi.org/10.1016/j.ejim.2015.12.017

Leise MD, Poterucha JJ, Talwalkar JA. Drug-induced liver injury. Mayo Clin Proc 2014;89:95–106.

https://doi.org/10.1016/j.mayocp.2013.09.016

Rangnekar AS, Fontana RJ. An update on drug induced liver injury. Minerva Gastroenterol Dietol 2011;57:213–29.

Dugum M, McCullough A. Diagnosis and Management of Alcoholic Liver Disease. J Clin Transl Hepatol 2015;3:109–16.

https://doi.org/10.14218/JCTH.2015.00008

Modaresi Esfeh J, Ansari-Gilani K. Steatosis and hepatitis C. Gastroenterol Rep 2016;4:24–9.

Versteeg HH, Heemskerk JWM, Levi M, Reitsma PH. New fundamentals in hemostasis. Physiol Rev 2013;93:327–58.

https://doi.org/10.1152/physrev.00016.2011

Stassen JM, Arnout J, Deckmyn H. The hemostatic system. Curr Med Chem 2004;11:2245–60.

https://doi.org/10.2174/0929867043364603

Golebiewska EM, Poole AW. Platelet secretion: From haemostasis to wound healing and beyond. Blood Rev 2015;29:153–62.

https://doi.org/10.1016/j.blre.2014.10.003

Roberts HR, Hoffman M, Monroe DM. A cell-based model of thrombin generation. Semin Thromb Hemost 2006;32 Suppl 1:32–8. https://doi.org/10.1055/s-2006-939552

Nilsson IM. Coagulation and fibrinolysis. Scand J Gastroenterol Suppl 1987;137:11–8.

https://doi.org/10.3109/00365528709089754

Chan AKC, Paredes N. The coagulation system in humans. Methods Mol Biol 2013;992:3–12.

https://doi.org/10.1007/978-1-62703-339-8_1

Tilg H, Moschen AR, Szabo G. Interleukin-1 and inflammasomes in alcoholic liver disease/acute alcoholic hepatitis and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Hepatology 2016;64:955–65. https://doi.org/10.1002/hep.28456

Kawaratani H, Tsujimoto T, Douhara A, Takaya H, Moriya K, Namisaki T, et al. The effect of inflammatory cytokines in alcoholic liver disease. Mediators Inflamm 2013;2013:495156.

https://doi.org/10.1155/2013/495156

Yang Y-Y, Lee T-Y, Huang Y-T, Chan C-C, Yeh Y-C, Lee F-Y, et al. Asymmetric dimethylarginine (ADMA) determines the improvement of hepatic endothelial dysfunction by vitamin E in cirrhotic rats. Liver Int 2012;32:48–57.

https://doi.org/10.1111/j.1478-3231.2011.02651.x

Vairappan B. Endothelial dysfunction in cirrhosis: Role of inflammation and oxidative stress. World J Hepatol 2015;7:443–59. https://doi.org/10.4254/wjh.v7.i3.443

Laleman W, Omasta A, Van de Casteele M, Zeegers M, Vander Elst I, Van Landeghem L, et al. A role for asymmetric dimethylarginine in the pathophysiology of portal hypertension in rats with biliary cirrhosis. Hepatology 2005;42:1382–90.

https://doi.org/10.1002/hep.20968

Pareja J, RestrepegoJC. Métodos diagnósticos en hipertensión portal. Rev Col Gastroenterol 2016;31:135–45.

Kmieć Z. Cooperation of liver cells in health and disease. Adv Anat Embryol Cell Biol 2001;161:III–XIII, 1-151.

https://doi.org/10.1007/978-3-642-56553-3_7

Murata S, Maruyama T, Nowatari T, Takahashi K, Ohkohchi N. Signal transduction of platelet-induced liver regeneration and decrease of liver fibrosis. Int J Mol Sci 2014;15:5412–25.

https://doi.org/10.3390/ijms15045412

Kurokawa T, Zheng Y-W, Ohkohchi N. Novel functions of platelets in the liver. J Gastroenterol Hepatol 2016;31:745–51.

https://doi.org/10.1111/jgh.13244

Gangireddy VGR, Kanneganti PC, Sridhar S, Talla S, Coleman T. Management of thrombocytopenia in advanced liver disease. Can J Gastroenterol Hepatol 2014;28:558–64.

https://doi.org/10.1155/2014/532191

Kaushansky K. Thrombopoiesis. Semin Hematol 2015;52:4–11. https://doi.org/10.1053/j.seminhematol.2014.10.003

Hitchcock IS, Kaushansky K. Thrombopoietin from beginning to end. Br J Haematol 2014;165:259–68.

https://doi.org/10.1111/bjh.12772

Panasiuk A, Prokopowicz D, Zak J, Panasiuk B. Reticulated platelets as a marker of megakaryopoiesis in liver cirrhosis; relation to thrombopoietin and hepatocyte growth factor serum concentration. Hepatogastroenterology 2004;51:1124–8.

McHutchison JG, Dusheiko G, Shiffman ML, Rodriguez-Torres M, Sigal S, Bourliere M, et al. Eltrombopag for thrombocytopenia in patients with cirrhosis associated with hepatitis C. N Engl J Med 2007;357:2227–36. https://doi.org/10.1056/NEJMoa073255

Afdhal NH, Dusheiko GM, Giannini EG, Chen PJ, Han KH, Mohsin A, et al. Eltrombopag increases platelet numbers in thrombocytopenic patients with hcv infection and cirrhosis, allowing for effective antiviral therapy. Gastroenterology 2014;146:442–52. https://doi.org/10.1053/j.gastro.2013.10.012

Afdhal NH, Giannini EG, Tayyab G, Mohsin A, Lee J-W, Andriulli A, et al. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia. N Engl J Med 2012;367:716–24.

https://doi.org/10.1056/NEJMoa1110709

Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol 2000;14:60D–66D.

https://doi.org/10.1155/2000/617428

Boyer TD, Habib S. Big spleens and hypersplenism: fix it or forget it? Liver Int 2015;35:1492–8.

https://doi.org/10.1111/liv.12702

Kedia S, Goyal R, Mangla V, Kumar A, S S, Das P, et al. Splenectomy in cirrhosis with hypersplenism: improvement in cytopenias, Child's status and institution of specific treatment for hepatitis C with success. Ann Hepatol 2012;11:921–9.

Akahoshi T, Tomikawa M, Kawanaka H, Furusyo N, Kinjo N, Tsutsumi N, et al. Laparoscopic splenectomy with interferon therapy in 100 hepatitis-C-virus-cirrhotic patients with hypersplenism and thrombocytopenia. J Gastroenterol Hepatol 2012;27:286–90.

https://doi.org/10.1111/j.1440-1746.2011.06870.x

Nakamura T, Sakata R, Ueno T, Sata M, Ueno H. Inhibition of transforming growth factor beta prevents progression of liver fibrosis and enhances hepatocyte regeneration in dimethylnitrosamine-treated rats. Hepatology 2000;32:247–55.

https://doi.org/10.1053/jhep.2000.9109

Nomura Y, Kage M, Ogata T, Kondou R, Kinoshita H, Ohshima K, et al. Influence of splenectomy in patients with liver cirrhosis and hypersplenism. Hepatol Res 2014;44:E100-9.

https://doi.org/10.1111/hepr.12234

Monroe DM, Hoffman M. The coagulation cascade in cirrhosis. Clin Liver Dis 2009;13:1–9.

https://doi.org/10.1016/j.cld.2008.09.014

Prelipcean CC, Fierbinteanu-Braticevici C, Drug VL, Lăcătuşu C, Mihai B, Mihai C. [Liver cirrhosis--procoagulant stasis]. Rev Med Chir Soc Med Nat Iasi 2011;115:678–85.

Muci-o-Bermejo J, Carrillo-Esper R, Uribe M, Méndez-Sánchez N. Coagulation abnormalities in the cirrhotic patient. Ann Hepatol 2013;12:713–24.

Donaldson GW, Davies SH, Darg A, Richmond J. Coagulation factors in chronic liver disease. J Clin Pathol 1969;22:199–204.

https://doi.org/10.1136/jcp.22.2.199

Mariani G, Bernardi F. Factor VII Deficiency. Semin Thromb Hemost 2009;35:400–6. https://doi.org/10.1055/s-0029-1225762

Zhang C, Wang Q, Zhang T, Xue D, Gong B. [Liver cirrhosis with factor VII deficiency: a case report and literature review]. Zhonghua Gan Zang Bing Za Zhi 2014;22:73–4.

De Stefano V, Martinelli I. Splanchnic vein thrombosis: clinical presentation, risk factors and treatment. Intern Emerg Med 2010;5:487–94. https://doi.org/10.1007/s11739-010-0413-6

Bianchini M, De Pietri L, Villa E. Coagulopathy in liver diseases: complication or therapy? Dig Dis 2014;32:609–14.

https://doi.org/10.1159/000360514

Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009;51:682–9.

https://doi.org/10.1016/j.jhep.2009.03.013

Valla D. Splanchnic Vein Thrombosis. Semin Thromb Hemost 2015;41:494–502.

https://doi.org/10.1055/s-0035-1550439

Wani ZA, Bhat RA, Bhadoria AS, Maiwall R. Extrahepatic portal vein obstruction and portal vein thrombosis in special situations: Need for a new classification. Saudi J Gastroenterol 2015;21:129–38.

https://doi.org/10.4103/1319-3767.157550

Monereo Mu-oz M, Aguilera García SG, de la Barreda Heusser R, González Arnay E, García Hernández S, González Reimers E. Cryptogenetic liver cirrhosis and prothrombotic mutations - A mere association? Rev Esp Enferm Dig 2016;108:588–91.

Lenting PJ, Christophe OD, Denis C V. von Willebrand factor biosynthesis, secretion, and clearance: connecting the far ends. Blood 2015;125:2019–28.

https://doi.org/10.1182/blood-2014-06-528406

Kujovich JL. Coagulopathy in liver disease: a balancing act. Hematology Am Soc Hematol Educ Program 2015;2015:243–9.

https://doi.org/10.1182/asheducation-2015.1.243

Uemura M, Fujimura Y, Ko S, Matsumoto M, Nakajima Y, Fukui H. Pivotal role of ADAMTS13 function in liver diseases. Int J Hematol 2010;91:20–9.

https://doi.org/10.1007/s12185-009-0481-4

Zheng XL. ADAMTS13 and von Willebrand factor in thrombotic thrombocytopenic purpura. Annu Rev Med 2015;66:211–25.

https://doi.org/10.1146/annurev-med-061813-013241

Uemura M, Matsuyama T, Ishikawa M, Fujimoto M, Kojima H, Sakurai S, et al. Decreased activity of plasma ADAMTS13 may contribute to the development of liver disturbance and multiorgan failure in patients with alcoholic hepatitis. Alcohol Clin Exp Res 2005;29:264S–71S.

https://doi.org/10.1097/01.alc.0000192326.08931.cb

Matsuyama T, Uemura M, Ishikawa M, Matsumoto M, Ishizashi H, Kato S, et al. Increased von Willebrand factor over decreased ADAMTS13 activity may contribute to the development of liver disturbance and multiorgan failure in patients with alcoholic hepatitis. Alcohol Clin Exp Res 2007;31:S27-35.

https://doi.org/10.1111/j.1530-0277.2006.00283.x

D'Alessio S, Genua M, Vetrano S. The protein C pathway in intestinal barrier function: challenging the hemostasis paradigm. Ann N Y Acad Sci 2012;1258:78–85.

https://doi.org/10.1111/j.1749-6632.2012.06557.x

Suleiman L, Négrier C, Boukerche H. Protein S: A multifunctional anticoagulant vitamin K-dependent protein at the crossroads of coagulation, inflammation, angiogenesis, and cancer. Crit Rev Oncol Hematol 2013;88:637–54.

https://doi.org/10.1016/j.critrevonc.2013.07.004

Dahlbäck B. Progress in the understanding of the protein C anticoagulant pathway. Int J Hematol 2004;79:109–16.

https://doi.org/10.1532/IJH97.03149

Denninger MH, Chaït Y, Casadevall N, Hillaire S, Guillin MC, Bezeaud A, et al. Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000;31:587–91. https://doi.org/10.1002/hep.510310307

van der Meer JHM, van der Poll T, van 't Veer C. TAM receptors, Gas6, and protein S: roles in inflammation and hemostasis. Blood 2014;123:2460–9.

https://doi.org/10.1182/blood-2013-09-528752

Pobbati A V, Hong W. Emerging roles of TEAD transcription factors and its coactivators in cancers. Cancer Biol Ther 2013;14:390–8.

https://doi.org/10.4161/cbt.23788

Colomo A, Puente A. Corrección de la coagulación en la hemorragia por varices en el paciente con cirrosis. ¿Es útil?. Gastroenterol Hepatol Contin 2011;10:175-9.

https://doi.org/10.1016/S1578-1550(11)70039-0

Muci-o-Bermejo J, Carrillo-Esper R, Uribe M, Méndez-Sánchez N. Coagulation abnormalities in the cirrhotic patient. Ann Hepatol 2013;12:713-24.

Vermeer C, Schurgers LJ. A comprehensive review of vitamin K and vitamin K antagonists. Hematol Oncol Clin North Am 2000;14:339–53. https://doi.org/10.1016/S0889-8588(05)70137-4

Booth SL, O'Brien-Morse ME, Dallal GE, Davidson KW, Gundberg CM. Response of vitamin K status to different intakes and sources of phylloquinone-rich foods: comparison of younger and older adults. Am J Clin Nutr 1999;70:368–77.

Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev 2009;23:49–59.

https://doi.org/10.1016/j.blre.2008.06.001

Shearer MJ, Fu X, Booth SL. Vitamin K nutrition, metabolism, and requirements: current concepts and future research. Adv Nutr 2012;3:182–95.

https://doi.org/10.3945/an.111.001800

Larson AE, Friedman PA, Suttie JW. Vitamin K-dependent carboxylase. Stoichiometry of carboxylation and vitamin K 2,3-epoxide formation. J Biol Chem 1981;256:11032–5.

von Kries R, Hachmeister A, Göbel U. Can 3 oral 2 mg doses of vitamin K effectively prevent late vitamin K deficiency bleeding? Eur J Pediatr 1999;S183-6.

https://doi.org/10.1007/PL00014352

Cornelissen M, von Kries R, Loughnan P, Schubiger G. Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K. Eur J Pediatr 1997;156:126–30. https://doi.org/10.1007/s004310050570

Gonsalves WI, Pruthi RK, Patnaik MM. The new oral anticoagulants in clinical practice. Mayo Clin Proc 2013;88:495–511. https://doi.org/10.1016/j.mayocp.2013.03.006

Bounameaux H. The novel anticoagulants: entering a new era. Swiss Med Wkly 2009;139:60–4.

Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G, et al. Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e44S–88S.

Wada H, Usui M, Sakuragawa N. Hemostatic abnormalities and liver diseases. Semin Thromb Hemost 2008;34:772–8.

https://doi.org/10.1055/s-0029-1145259

Lisman T, Leebeek FWG. Hemostatic alterations in liver disease: a review on pathophysiology, clinical consequences, and treatment. Dig Surg 2007;24:250–8.

https://doi.org/10.1159/000103655

Martí-Carvajal AJ, Solà I. Vitamin K for upper gastrointestinal bleeding in patients with acute or chronic liver diseases. Cochrane database Syst Rev 2012;CD004792.

https://doi.org/10.1002/14651858.CD004792.pub4

Barton CA. Treatment of Coagulopathy Related to Hepatic Insufficiency. Crit Care Med 2016;44:1927–33.

https://doi.org/10.1097/CCM.0000000000001998

Ditisheim S, Goossens N, Spahr L, Hadengue A. [Coagulation and cirrhosis: new insight]. Rev Med Suisse 2012;8:1652, 1654–6.

Publicado
2017-12-19
Cómo citar
Ramos Peñafiel, C. O., Santoyo Sánchez, A., Castellanos S, H., Martínez M, C., Olarte, I., & Martínez M, A. (2017). Insuficiencia hepática crónica y hemostasia. Revista Colombiana De Gastroenterología, 32(4), 349-367. https://doi.org/10.22516/25007440.178
Sección
Revisión de tema
Crossref Cited-by logo

Más sobre este tema