Disseminated intravascular coagulation versus cirrhosis-associated coagulopathy： Diagnostic challenges and clinical strategies
- VernacularTitle:弥散性血管内凝血与肝硬化凝血功能障碍： 鉴别误区与临床对策
- Author:
Siyi LEI
1
;
Hong PENG
1
;
Xiaofeng WANG
1
;
Xinhua LUO
2
Author Information
- Publication Type:Journal Article
- Keywords: Disseminated Intravascular Coagulation; Liver Cirrhosis; Hemostasis; Thrombelastography
- From: Journal of Clinical Hepatology 2026;42(9):2014-2021
- CountryChina
- Language:Chinese
- Abstract: The hemostatic function in patients with liver cirrhosis is not simply in a state of hypocoagulability， but rather a fragile rebalanced state resulting from the simultaneous remodeling of procoagulant and anticoagulant systems， the von Willebrand factor-platelet axis， and the fibrinolytic system. Since patients with liver cirrhosis frequently exhibit laboratory abnormalities including thrombocytopenia， prolonged prothrombin time/international normalized ratio， abnormal fibrinogen level， and elevated D-dimer， these manifestations substantially overlap with the laboratory phenotype of disseminated intravascular coagulation （DIC）， leading to potential misdiagnosis and unnecessary blood product transfusion or correction of coagulation parameters in clinical practice. Current evidence suggests that factor Ⅷ level and the widely used International Society on Thrombosis and Haemostasis DIC scoring system have limited value in differential diagnosis in patients with liver disease， and there is still a lack of a unified pathway for differential diagnosis. This article systematically reviews the pathophysiological overlap between rebalanced hemostasis in liver cirrhosis and DIC and summarizes the diagnostic value of conventional coagulation parameters， emerging hemostatic biomarkers， and global hemostatic assays in differential diagnosis of these conditions. Furthermore， it proposes a four-step diagnostic pathway of “trigger identification， baseline comparison， dynamic monitoring， and organ assessment” with reference to the specific clinical scenarios including infection， acute decompensation， gastrointestinal bleeding， hepatocellular carcinoma， and the perioperative period. In the future， DIC prediction models based on the features of liver disease should be established in combination with viscoelastic testing and multidimensional biomarkers， so as to achieve precise risk stratification and individualized management of coagulation abnormalities in patients with liver cirrhosis.
