Hemostatic System in Chronic Viral Hepatitis

Hemostasis is balanced by pro- and anticoagulant and pro- and antifibrinolytic factors, most of these being synthesized by the liver. Advanced liver disease is associated with perturbations in the level of these factors due to secretory deficiencies. Thrombocytopenia, reduced levels of factor II-VII-X, and anti-fibrinolytic factors are all features of CHC infection, suggesting hypocoagulability. However, higher concentrations of VWF and factor VIII, as well as lower concentrations of anticoagulant factors including protein C and S, have also been reported in CHC infections, suggesting hypercoagulability. Thus, the hemostatic balance in the patient with liver disease is relatively unstable as evidenced by the occurrence of both bleeding and thrombotic complications in a significant proportion of patients with chronic viral hepatitis. In patients with chronic liver disease (CLD), in whom extremely complex alterations of hemostasis occur, one cannot rely on levels of individual coagulation factors, or on simplified tests of hemostasis such as the PT or APTT to predict the hemostatic status. To determine the hemostatic status in these patients, more complex tests and a more comprehensive overview of the hemostatic changes are required. In connection with the latest studies, a revision of the methods for correction of hemostatic system disorders in patients with acute and chronic liver diseases becomes urgent.