Erika Čellárová, Ľubomír Skladaný
Cirrhosis of the liver leads to significant changes in haemostasis. Based on traditionally used haemostatic examinations,
these changes are believed to cause excessive bleeding particularly in connection with invasive interventions. However,
this concept, in the light of new findings, seems to be outdated. The article aims to highlight the fact that the reasons
why patients bleed are usually not connected with haemostatic changes. The prime reasons mainly link to associated
health problems such as renal insufficiency, bacterial infection or portal hypertension. Other important factors,
which seem to change our understanding of patients with cirrhosis of the liver, are thrombotic events and their consequences.
Patients suffering from cirrhosis, similarly to healthy population, are able to create coagulum because there
is an alternation of pro-haemostatic and anti-haemostatic factors resulting in a new haemostatic balance referred to
as „rebalanced haemostasis“ in English- speaking academic sources. There is evidence that with the progression of cirrhosis
there is a tendency towards hypercoagulation in vitro and the condition is referred to as pro-thrombotic state.
There seems to be an urgent need for new examination methods as well as scoring systems which would allow stratification
of patients according to the risk of haemorrhage or thrombosis. Traditional coagulation tests (PT and PTT) seem
to be insufficient. Equally urging is the need to pursue specialized treatment procedures to be able to deal with haemorrhage
and thrombosis.