ʻO ka hana ʻole o ka coagulation kahi ʻāpana o ka maʻi akepaʻa a he kumu nui ia i ka hapa nui o nā helu prognostic. ʻO nā loli i ke kaulike o ka hemostasis e alakaʻi ai i ke kahe koko, a ʻo nā pilikia kahe koko he pilikia lapaʻau nui ia. Hiki ke hoʻokaʻawale ʻia nā kumu o ke kahe koko i (1) ka hypertension portal, ʻaʻohe mea pili i ka ʻano hemostatic; (2) ke kahe koko mucosal a i ʻole ka puncture, pinepine me ka hoʻoheheʻe mua ʻana o ka thrombus a i ʻole ka fibrinolysis kiʻekiʻe, i kapa ʻia ʻo ka accelerated intravascular coagulation a me ka fibrinolysis i ka maʻi akepaʻa Melt (AICF). ʻAʻole maopopo ke ʻano o ka hyperfibrinolysis, akā pili ia i nā loli i ka coagulation intravascular a me ka fibrinolysis. ʻIke ʻia ka coagulation maʻamau ʻole i ka portal vein thrombosis (PVT) a me ka mesenteric vein thrombosis, a me ka deep vein thrombosis (DVT). Pono pinepine kēia mau kūlana lapaʻau i ka mālama anticoagulation a i ʻole ka pale ʻana. ʻO ka Microthrombosis i loko o ke akepaʻa i hoʻokumu ʻia e ka hypercoagulability e hoʻoulu pinepine i ka atrophy akepaʻa.
Ua wehewehe ʻia kekahi mau loli koʻikoʻi i ke ala hemostasis, ʻo kekahi e kahe ke koko a ʻo kekahi e ʻūlū (Kiʻi 1). I ka cirrhosis ate paʻa, e hoʻoponopono hou ʻia ka ʻōnaehana ma muli o nā mea i hoʻoponopono ʻole ʻia, akā paʻa ʻole kēia kaulike a e hoʻopilikia nui ʻia e nā mea ʻē aʻe, e like me ke kūlana o ka nui o ke koko, ka maʻi ʻōnaehana, a me ka hana o nā puʻupaʻa. ʻO ka Thrombocytopenia paha ka loli pathological maʻamau ma muli o ka hypersplenism a me ka emi ʻana o ka thrombopoietin (TPO). Ua wehewehe pū ʻia ka hana ʻole o ka platelet, akā ua hoʻopau nui ʻia kēia mau loli anticoagulant e ka hoʻonui ʻana o ka endothelial-derived von Willebrand factor (vWF). Pēlā nō, ʻo ka emi ʻana o nā mea procoagulant i loaʻa mai ke ake, e like me nā mea V, VII, a me X, e alakaʻi ai i ka manawa prothrombin lōʻihi, akā ua hoʻopau nui ʻia kēia e ka emi ʻana o nā mea anticoagulant i loaʻa mai ke ake (ʻoi aku ka protein C). Eia kekahi, ʻo ka endothelial-derived factor VIII kiʻekiʻe a me ka protein C haʻahaʻa e alakaʻi ai i kahi kūlana hypercoagulable. ʻO kēia mau loli, me ka stasis venous pili a me ka hōʻino endothelial (Virchow's triad), ua alakaʻi i ka holomua synergistic o PVT a me ka DVT i kekahi manawa i nā poʻe maʻi me ka cirrhosis ate. I ka pōkole, ua hoʻoponopono hou ʻia nā ala hemostatic o ka cirrhosis ate ma ke ʻano paʻa ʻole, a hiki ke hoʻohuli ʻia ka holomua o ka maʻi i kekahi ʻaoʻao.
Kuhikuhi：O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Clinical Practice Update: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
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