Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 18, 2015; 7(14): 1818-1827
Published online Jul 18, 2015. doi: 10.4254/wjh.v7.i14.1818
Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most?
Kryssia Isabel Rodríguez-Castro, Alessandro Antonello, Alberto Ferrarese
Kryssia Isabel Rodríguez-Castro, Alberto Ferrarese, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
Alessandro Antonello, Veneto Oncological Institute (IOV-IRCCS), 35128 Padua, Italy
Author contributions: All the authors equally contributed to this work.
Conflict-of-interest statement: All Authors declare they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Kryssia Isabel Rodríguez-Castro, MD, PhD, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy. kryssiarodriguez@yahoo.com
Telephone: +39-33-36167592 Fax: +39-49-8218727
Received: January 29, 2015
Peer-review started: March 2, 2015
First decision: March 6, 2015
Revised: March 30, 2015
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: July 18, 2015
Core Tip

Core tip: The two-faced, dynamic, and fragile hemostatic and coagulation system of patients with cirrhosis is of increasing interest. Thrombotic complications, and not only the well-known bleeding complications such as gastroesophageal bleeding, are now recognized complications of cirrhosis. Whether confined to the portal vein, due to venous stasis but also to other yet poorly characterized local as well as systemic factors, or in the presence venous thromboembolism, these complications warrant prevention and treatment with anticoagulation. Future clinical studies, as well as the broader implementation of point-of-care instruments and results from studies using global coagulation assays will outline the best strategies, tailored to each patient according to the severity of liver disease and the particular hemostatic alterations present at a given timepoint.