Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic environment.Thrombocytopenia is the most common abnormality observed in these patie...Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic environment.Thrombocytopenia is the most common abnormality observed in these patients and recent advances have led to researchers focus the attention on the multifactorial origin of thrombocytopenia and on the key role of thrombopoietin(TPO)in its physiopathology.Severe thrombocytopenia(platelet count<50000/μL)complicates the management of patients with chronic liver disease by increasing the potential risk of bleeding for invasive procedures,which may be therefore delayed or canceled even if lifesaving.In the very last years,the development of new drugs which exceed the limits of the current standard of care(platelet transfusions,either immediately before or during the procedure)paves the way to a new scenario in the management of this population of patients.Novel agents,such as the TPOreceptor agonists avatrombopag and lusutrombopag,have been developed in order to increase platelet production as an alternative to platelet transfusions.These agents have demonstrated a good profile in terms of efficacy and safety and will hopefully allow reducing limitations and risks associated with platelet transfusion,without any delay in scheduled interventions.Altogether,it is expected that patients with chronic liver disease will be able to face invasive procedures with one more string in their bow.展开更多
Sarcopenia is a well-known complication of chronic liver disease(CLD),and it is almost always observed in patients with cirrhosis,at least in those with decompensated disease.Since nonalcoholic fatty liver disease(NAF...Sarcopenia is a well-known complication of chronic liver disease(CLD),and it is almost always observed in patients with cirrhosis,at least in those with decompensated disease.Since nonalcoholic fatty liver disease(NAFLD),recently renamed metabolic dysfunction-associated steatotic liver disease(MASLD),is becoming the leading cause of end-stage liver disease,a new scenario characterized by the frequent coexistence of NAFLD,obesity,and sarcopenia is emerging.Although it is not yet resolved whether the bidirectional relationship between sarcopenia and NAFLD subtends causal determinants,it is clear that the interaction of these two conditions is associated with an increased risk of poor outcomes.Notably,during the course of CLD,deregulation of the liver-muscle-adipose tissue axis has been described.Unfortunately,owing to the lack of properly designed studies,specific therapeutic guidelines for patients with sarcopenia in the context of NAFLD-related CLD have not yet been defined.Strategies aimed to induce the loss of fat mass together with the maintenance of lean body mass seem most appropriate.This can be achieved by properly designed diets integrated with specific nutritional supplementations and accompanied by adequate physical exercise.Future studies aiming to add to the knowledge of the correct assessment and approach to sarcopenia in the context of NAFLD-related CLD are eagerly awaited.展开更多
文摘Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic environment.Thrombocytopenia is the most common abnormality observed in these patients and recent advances have led to researchers focus the attention on the multifactorial origin of thrombocytopenia and on the key role of thrombopoietin(TPO)in its physiopathology.Severe thrombocytopenia(platelet count<50000/μL)complicates the management of patients with chronic liver disease by increasing the potential risk of bleeding for invasive procedures,which may be therefore delayed or canceled even if lifesaving.In the very last years,the development of new drugs which exceed the limits of the current standard of care(platelet transfusions,either immediately before or during the procedure)paves the way to a new scenario in the management of this population of patients.Novel agents,such as the TPOreceptor agonists avatrombopag and lusutrombopag,have been developed in order to increase platelet production as an alternative to platelet transfusions.These agents have demonstrated a good profile in terms of efficacy and safety and will hopefully allow reducing limitations and risks associated with platelet transfusion,without any delay in scheduled interventions.Altogether,it is expected that patients with chronic liver disease will be able to face invasive procedures with one more string in their bow.
文摘Sarcopenia is a well-known complication of chronic liver disease(CLD),and it is almost always observed in patients with cirrhosis,at least in those with decompensated disease.Since nonalcoholic fatty liver disease(NAFLD),recently renamed metabolic dysfunction-associated steatotic liver disease(MASLD),is becoming the leading cause of end-stage liver disease,a new scenario characterized by the frequent coexistence of NAFLD,obesity,and sarcopenia is emerging.Although it is not yet resolved whether the bidirectional relationship between sarcopenia and NAFLD subtends causal determinants,it is clear that the interaction of these two conditions is associated with an increased risk of poor outcomes.Notably,during the course of CLD,deregulation of the liver-muscle-adipose tissue axis has been described.Unfortunately,owing to the lack of properly designed studies,specific therapeutic guidelines for patients with sarcopenia in the context of NAFLD-related CLD have not yet been defined.Strategies aimed to induce the loss of fat mass together with the maintenance of lean body mass seem most appropriate.This can be achieved by properly designed diets integrated with specific nutritional supplementations and accompanied by adequate physical exercise.Future studies aiming to add to the knowledge of the correct assessment and approach to sarcopenia in the context of NAFLD-related CLD are eagerly awaited.
