Until recently,anti-platelet/coagulation therapy had not been recommended for patients with cirrhosis.Although venous thrombosis is one of the representative complications of cirrhosis and ischemic disorders associate...Until recently,anti-platelet/coagulation therapy had not been recommended for patients with cirrhosis.Although venous thrombosis is one of the representative complications of cirrhosis and ischemic disorders associated with atherosclerosis are not infrequent in cirrhotic patients,many clinicians have tended to hesitate to introduce anti-platelet/coagulation therapy to their patients.Undoubtedly,this is due to the increased risk of hemorrhagic diathesis in cirrhotic patients.However,accumulating evidence has revealed the benefits of anti-platelet/coagulation therapy for cirrhotic patients.In addition to the safety of the therapy carried out against cardiovascular diseases in cirrhotic patients,some clinical data have indicated its preventive effect on venous thrombosis.Moreover,the efficacy of antiplatelet/coagulation therapy against cirrhosis itself has been demonstrated both clinically and experimentally.The conceptual basis for application of anti-platelet/coagulation therapy against cirrhosis was constructed through two pathologic studies on intrahepatic thrombosis in cirrhotic livers.It may be better to use thrombopoietinreceptor agonists,which have been tested as a treatment for cirrhosis-related thrombocytopenia,in combination with anti-platelet drugs to reduce the risk of venous thrombosis.During the last decade,the World Journal of Gastroenterology,a sister journal of World Journal of Hepatology,has been one of the main platforms of active discussion of this theme.展开更多
BACKGROUND Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages.The underlying disorder ca...BACKGROUND Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages.The underlying disorder causing the development of an autoimmune phenomenon is not always known,but 10%-15%could be linked to malignancies.Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy.CASE SUMMARY We present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease.Haemostasis was established with recombinant activated factor VII,and immunosuppressive therapy was started immediately.An extensive surgical procedure was performed in order to remove the cancer and,therefore,eliminate the inhibitory autoantibodies.Due to a complicated postoperative course,relatively short period of treatment and likelihood of micrometastases,no improvement in the patient’s status was observed.Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed.CONCLUSION Prompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality.Among patients with cancer,other causes of abnormal bleeding related to malignancy should be considered.展开更多
文摘Until recently,anti-platelet/coagulation therapy had not been recommended for patients with cirrhosis.Although venous thrombosis is one of the representative complications of cirrhosis and ischemic disorders associated with atherosclerosis are not infrequent in cirrhotic patients,many clinicians have tended to hesitate to introduce anti-platelet/coagulation therapy to their patients.Undoubtedly,this is due to the increased risk of hemorrhagic diathesis in cirrhotic patients.However,accumulating evidence has revealed the benefits of anti-platelet/coagulation therapy for cirrhotic patients.In addition to the safety of the therapy carried out against cardiovascular diseases in cirrhotic patients,some clinical data have indicated its preventive effect on venous thrombosis.Moreover,the efficacy of antiplatelet/coagulation therapy against cirrhosis itself has been demonstrated both clinically and experimentally.The conceptual basis for application of anti-platelet/coagulation therapy against cirrhosis was constructed through two pathologic studies on intrahepatic thrombosis in cirrhotic livers.It may be better to use thrombopoietinreceptor agonists,which have been tested as a treatment for cirrhosis-related thrombocytopenia,in combination with anti-platelet drugs to reduce the risk of venous thrombosis.During the last decade,the World Journal of Gastroenterology,a sister journal of World Journal of Hepatology,has been one of the main platforms of active discussion of this theme.
文摘BACKGROUND Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages.The underlying disorder causing the development of an autoimmune phenomenon is not always known,but 10%-15%could be linked to malignancies.Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy.CASE SUMMARY We present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease.Haemostasis was established with recombinant activated factor VII,and immunosuppressive therapy was started immediately.An extensive surgical procedure was performed in order to remove the cancer and,therefore,eliminate the inhibitory autoantibodies.Due to a complicated postoperative course,relatively short period of treatment and likelihood of micrometastases,no improvement in the patient’s status was observed.Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed.CONCLUSION Prompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality.Among patients with cancer,other causes of abnormal bleeding related to malignancy should be considered.
