Figure 3. Hemostasis in Hepatic Failure and Renal Disease.
Liver failure (Panel A) leads to complex hemostatic changes, since the liver is the producer of coagulation factors, physiologic anticoagulants,
and thrombopoietin, as well as the site of the metabolism of sialic acid residues from fibrinogen, activated coagulation factors, and
tissue plasminogen activator. These defects result in poor coagulation reserve, dysfibrinogenemia, and increased fibrinolytic potential.
In renal failure (Panel B), decreased production of erythropoietin produces anemia, which results in a loss of axial flow so that the bleeding
time is prolonged. The accumulation of uremic toxins results in platelet dysfunction. APTT denotes activated partial-thromboplastin time,
PT prothrombin time, TAFI thrombin-activatable fibrinolysis inhibitor, and t-PA tissue plasminogen activator.