Liver 2009, Vol 13, Issues 1, Coagulation And Hemostasis In Liver Disease - Controversies And Advances.pdf

Coagulation and Hemostasis in Liver Disease: Controversies and Advances
Preface
Stephen H. Caldwell, MD Arun J. Sanyal, MD
Guest Editors
Few fields of medicine have changed as rapidly as that of hepatology in the past fifteen to
twenty years. However, the management of coagulation disorders, an inherent aspect of
all types of progressive liver failure, seemed to lag behind other areas for a long time and
has remained mired in old dogma and unproven practice guidelines often guided more
by legal concerns than by scientific evidence or rational reason. This situation has now
changed dramatically over the past several years, with a number of e advances
ushered in by landmark papers from Tripodi and colleagues, the development of new
therapeutics and with it the improved understanding of normal hemostasis. Additional
refinements in diagnostic tests have been greatly advanced by the pioneering work of
Burroughs and colleagues. These advances have led to the appreciation of the multifac-
eted aspects of coagulation disorders in liver disease from hypo-coagulable to hyper-
coagulable states and the limitations of conventional tests, such as the INR, to shed light
on relative bleeding risk or on underlying pathophysiology in a given patient.
In this issue of Clinics in Liver Disease, we are very happy to present a collection of
original articles from leaders in the field, and from multiple disciplines, from around the
world. Each article discusses the state of the art along with its limitations. Our aim is to
shed light on recent advances and to explore areas of controversy and, thus, the need
bined clinical and laboratory investigation. We hope this issue will stimulate fur-
ther research on this important issue in liver diseases.
Stephen H. Caldwell, MD
GI/Hepatology Division
Digestive Health Center of Excellence
University of Virginia Medical Center
Box 800708, Charlottesville, VA 22908-0708
Arun J. Sanyal, MD
Division of GI/Hepatolo