Description:
Advanced chronic liver disease results in complex changes to hemostasis due to changes in liver synthetic function, portal hypertension with consequent hypersplenism, and endothelial activation. Patients with cirrhosis are at increased risk of both bleeding, predominantly due to portal hypertension and thrombosis, typically involving the portal vasculature. This education session reviews the laboratory assessment of hemostasis in patients with cirrhosis, management of peri-procedural bleeding risk. Finally, management of splanchnic vein thrombosis in patients with cirrhosis is discussed, including the approach in patients who present with gastrointestinal bleeding or with thrombocytopenia, and the role of direct oral anticoagulants.

Prof Ton Lisman will present the current understanding of hemostasis in patients with advanced chronic liver disease. Currently available routine and research laboratory assays will be presented with regard to their role, interpretation and limitations in the evaluation of hemostasis in this patient group.

Dr Lara Roberts will discuss how to evaluate the peri-procedural bleeding risk of patients with advanced chronic liver disease. The role and limitations of the available hemostatic therapies for prevention of procedural bleeding will be explored. Dr Roberts will present societal guidance recommendations for clinical practice and highlight priorities for future research.

Prof Walter Ageno will initially focus on the association between advanced chronic liver disease, and splanchnic vein thrombosis. Prof Ageno will discuss the challenges in the initial management of splanchnic vein thrombosis in this patient group, with particular emphasis on patients presenting with gastrointestinal bleeding, or at high risk of bleeding due to thrombocytopenia and/or esophageal varices. Finally, the talk will review the available evidence for risks and benefits of anticoagulation in this setting, including the role of the direct oral anticoagulants.