Thrombopoietin and most hemostatic proteins
are synthesized in the liver. Thus, reduced hepatic
synthetic function results in prolongation
of the screening tests of coagulation (particularly
the prothrombin time) and reduced platelet counts,
although levels of factor VIII and von Willebrand
factor are increased.35 Acute alcohol intake inhibits
platelet aggregation. In chronic liver disease,
there is also increased fibrinolytic potential
due to the failure of the liver to metabolize tissue
plasminogen activator. In cholestatic liver disease,
there is reduced absorption of lipid-soluble
vitamins, so reduced amounts of the vitamin K–
dependent coagulation factors II, VII, IX, and X
are produced. Furthermore, in liver disease, the
failure of the normal enzymatic removal of sialic
acid from fibrinogen results in dysfibrinogenemia36
(Fig. 3A).
Thrombopoietin and most hemostatic proteinsare synthesized in the liver. Thus, reduced hepaticsynthetic function results in prolongationof the screening tests of coagulation (particularlythe prothrombin time) and reduced platelet counts,although levels of factor VIII and von Willebrandfactor are increased.35 Acute alcohol intake inhibitsplatelet aggregation. In chronic liver disease,there is also increased fibrinolytic potentialdue to the failure of the liver to metabolize tissueplasminogen activator. In cholestatic liver disease,there is reduced absorption of lipid-solublevitamins, so reduced amounts of the vitamin K–dependent coagulation factors II, VII, IX, and Xare produced. Furthermore, in liver disease, thefailure of the normal enzymatic removal of sialicacid from fibrinogen results in dysfibrinogenemia36(Fig. 3A).
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