Clinical aspects of bleeding complications in cirrhotic patients

Liver disease is a frequent cause of haemostatic abnormalities, which may l ead to overt or occult bleeding. Clinical manifestations of hepatic coagulo pathy include upper and lower gastrointestinal haemorrhage, easy bruising a nd bleeding from gums, nose or the female genital tract. The most significa nt bleeding problem among patients with chronic liver disease is blood loss due to portal hypertension. About 30% of subjects with oesophageal or gast ric varices resulting from cirrhosis have an episode of gastrointestinal bl eeding in their lifetime. Risk factors for the first episode of variceal bl eeding include the severity of liver dysfunction, large varices, and the pr esence of endoscopic red colour signs. Bacterial infection in patients with variceal haemorrhage may be critical in triggering bleeding. Nongastrointe stinal bleeding events, either spontaneous or induced by minor trauma, are also a common complication of advanced cirrhosis. In women, for instance, d ysfunctional uterine bleeding may become so severe that hysterectomy is req uired. In addition, invasive diagnostic tests (mostly solid tissue biopsies ) and surgical procedures have a high risk of haemorrhage and are sometimes withheld in cirrhotic patients for fear of complications. In patients with portal hypertension, surgical procedures aggravate the injury of the hepat ic parenchyma and may worsen the condition. Blood Coagul Fibrinolysis 11 (s uppl 1):S75-S79 (C) 2000 Lippincott Williams & Wilkins.