| Popis: |
The hemostatic derangements accompanying liver disease are complex and affect all aspects of hemostasis. Depressed levels of the major natural anticoagulants (NAs): Antithrombin (AT), protein C (PC), protein S (PS), and tissue factor pathway inhibitor (TFPI) were reported in advanced liver disease and this reduction correlated with the severity of liver disease. Recent evidence suggests that changes in the blood levels of NAs particularly, PS and PC, were found to be more sensitive to hepatocyte dysfunction than the conventional coagulation tests prothrombin time and activated partial thromboplastin time. Depressed levels of PS and PC were found even in the mildest forms of liver disease such as chronic viral hepatitis and its carrier state when the other coagulation tests and routine liver function tests were normal. This topic did not receive enough coverage and was not described in many recent publications. The current review provides an overview of the current understanding of the pathophysiology of the major anticoagulants; AT, PC, PS, and TFPI with a particular focus on their fluctuations in different types of liver disease. It also discusses the emerging important roles of these NAs as sensitive markers of liver disease. |
