engleski

Simultaneous Arterial and Venous Thromboembolic Incidents in a Patient with Liver Cirrhosis

Introduction: There is a widespread opinion that patients with liver cirrhosis are protected from thromboembolic incidents, largely because of the increased risk of bleeding and altered conventional coagulation tests. However, an increasing number of publications confirm the opposite. We present a case report of liver cirrhosis patients with multiple thromboembolic incidents. Case report: A 50-year-old patient with previously known liver cirrhosis of alcoholic etiology presented with weakness of the left body side, right-sided homonymous hemianopsia, and abdominal pain. The patient was diagnosed with ischemic lesions of the left occipital lobe, multiple spleen infarctions, and thrombosis of the portal, lineal, and mesenteric veins. Discussion: Disrupted balance of the synthesis of anti- and procoagulant factors in patients with liver cirrhosis underlies the increased incidence of thromboembolic incidents in these patients compared with the general population. Despite the reduced number of platelets, elevated von Willebrand factor levels often compensate for this imbalance. Genetic polymorphisms in Factor II, Factor V, and methyltetrahydrofolate reductase (involved in homocysteine metabolism) are associated with patients with liver cirrhosis who develop thromboembolic incidents. Conclusion: This case provides yet more insight in the elevated incidence of thromboembolic incidents in patients with liver cirrhosis compared with the general population. Despite the popular view that these patients are protected from these incidents, they are not uncommon and should be considered during patient treatment.

Coagulation; Cirrhosis; Stroke; Thrombosis; Infarction

nije evidentirano