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Semin Thromb Hemost 2015; 41(05): 481-487
DOI: 10.1055/s-0035-1550438
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prediction of Esophageal Variceal Bleeding in Liver Cirrhosis: Is There a Role for Hemostatic Factors?

Francisco Barrera
1   Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
,
Pamela Zúñiga
2   Departamento de Oncología-Hematología, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
,
Marco Arrese
1   Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Publikationsverlauf

Publikationsdatum:
06. Juni 2015 (online)

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Abstract

Variceal bleeding is a frequent and ominous complication of liver cirrhosis. Fortunately, primary prophylaxis with β blockers or esophageal band ligation effectively reduces the risk of variceal bleeding and its associated mortality. Periodic endoscopic surveillance of esophageal varices (EV) is currently recommended in every patient with cirrhosis for early detection of EV and initiation of primary variceal bleeding prophylaxis is indicated for high-risk patients. During the last decades several noninvasive tests have emerged, aiming to facilitate access, reduce cost, and avoid unnecessary risk associated with endoscopic EV surveillance. In addition, several hemostatic abnormalities have been described in cirrhosis, and their role in variceal bleeding pathogenesis is yet to be defined. In this article, we review and critically analyze the accuracy of noninvasive EV predictors and utility of hemostatic factors to predict individual variceal bleeding risk. In addition, we summarize available data regarding the therapeutic role of hemostatic factors in primary prevention of variceal bleeding and early recurrence after an initial episode of variceal hemorrhage.

Keywords

variceal bleeding - liver - cirrhosis - hemostasis - blood coagulation - gastrointestinal hemorrhage
 

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