Alteraciones de la hemostasia en la cirrosis hepática

espanolLa cirrosis hepatica va ligada a importantes alteraciones hematologicas afectando a los mecanismos de hemostasia primaria, coagulacion y fibrinolisis. En los ultimos anos, se ha demostrado que las alteraciones se asocian no solo a eventos hemorragicos sino tambien tromboticos, dentro de un equilibrio hemostasico rebalanceado. Los parametros analiticos clasicos para medir la coagulacion no reflejan, en el paciente cirrotico, la verdadera situacion de la hemostasia, ni el riesgo de trombosis o hemorragia. Todo esto ha llevado a que cambien las recomendaciones en relacion con el riesgo trombotico, en especial en la hospitalizacion, y a que se proponga un abordaje terapeutico precoz en la trombosis portal. En la presente revision, se analizan los fenomenos fisiopatologicos hematologicos observados en este area, la interpretacion de los resultados analiticos habituales, y los fenomenos clinicos asociados, asi como su abordaje recomendado. EnglishCirrhosis of the liver is linked to important haematological alterations affecting the mechanisms of primary haemostasis, coagulation and fibrinolysis. In recent years, it has been shown that the alterations are associated not only with hemorrhagic but also thrombotic events, within a rebalanced hemostatic balance. The classical analytical parameters for measuring coagulation do not reflect, in the cirrhotic patient, the true situation of the hemostasis, nor the risk of thrombosis or hemorrhage. All this has led to a change in recommendations regarding thrombotic risk, especially in hospitalisation, and to the proposal of an early therapeutic approach to portal thrombosis. In this review, we analyze the pathophysiological hematological phenomena observed in this area, the interpretation of the usual analytical results, and the associated clinical phenomena, as well as their recommended approach.