The Complex Role of Anticoagulation in Cirrhosis: An Updated Review of Where We Are and Where We Are Going

Tawfik Khoury, Abu Rmeileh Ayman, Jonah Cohen, Saleh Daher, Chen Shmuel, Meir Mizrahi

Research output: Contribution to journalReview articlepeer-review

39 Scopus citations


Venous thromboembolism (VTE) in cirrhotic patients is an increasingly encountered problem in the daily clinical practice; there is still a debate on the ideal measures to be followed for prophylaxis and treatment of VTE among this population. Although traditionally, liver cirrhosis has been considered a disease with hypocoagulability state and increasing bleeding tendency due to severe homeostatic disruption in liver disease, until recently there is increasing awareness and evidence that cirrhotic patients are not completely protected from thrombotic events although they have an elevated international normalized ratio and auto anticoagulation. Furthermore, hypercoagulability is now an increasingly recognized aspect of chronic liver disease (CLD), and the bleeding risk of VTE prophylaxis and treatment remains unclear. In this review, we provide an updated discussion on the mechanisms involved in hemostasis in CLD as well as on the benefits and complications of anticoagulant therapy in cirrhotic patients. Overall, sufficient evidence exists, promoting the use of anticoagulation in cirrhotic patients for both VTE prophylaxis and treatment in carefully selected patients after consideration of pharmacologic or endoscopic variceal bleeding prophylaxis.

Original languageEnglish
Pages (from-to)149-159
Number of pages11
Issue number2
StatePublished - 1 Mar 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 S. Karger AG, Basel.


  • Anticoagulation
  • Cirrhosis
  • Venous thromboembolism


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