Selecting anticoagulant therapy in patients with cirrhosis

Patients with liver diseases have a higher risk of hemostatic disorders. Meanwhile, despite a well-established opinion on a low risk of thromboses in cirrhosis, thromboembolic events cannot be totally ruled out in these patients. Increased risks of thrombotic events and venous thromboembolism in cirrhosis are accounted for by external (immobilization, surgeries, infections, comorbidities) and internal factors (reduced synthesis of anticoagulants, increased levels of estrogens). Practically, the selection of anticoagulant therapy in cirrhosis is difficult because of divergent hemostatic disorders and requires continuous and careful monitoring of hemostasis. In 2019, the American Gastroenterological Association (AGA) released guidelines on anticoagulant therapy in patients with cirrhosis and pulmonary embolism. We describe a patient with cirrhosis and pulmonary embolism. A management strategy was tailored to the AGA guidelines, the Russian Society on Liver Research guidelines, and the Russian Gastroenterological Association on Fibrosis and Cirrhosis and Complication Diagnosis and Treatment guidelines. This example of successful selection of anticoagulant therapy, multidisciplinary approach, and dynamic evaluation of all available methods of hemostasis control will be useful for practitioners. KEYWORDS: cirrhosis, hemostasis, thrombosis, hemorrhage, venous thromboembolism, pulmonary embolism, thromboelastometry, anticoagulant, low-molecular-weight heparin. FOR CITATION: Arykan N.G., Shestopalov A.E., Khvorostinina E.E. et al. Selecting anticoagulant therapy in patients with cirrhosis. Russian Medical Inquiry. 2022;6(5):286–292 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-286-292.