What Does the Liver Do?

The liver is an important part of our digestive system. Firstly, it helps digestion by filtering nutrients and waste passing through the digestive system. It also produces bile (a fluid needed to digest fat) and some hormones and proteins used by other parts of the body. Finally, it stores important minerals and vitamins for whenever our body needs them.

What Is Liver Disease?

Liver disease is when the liver is sick. It can be caused by long-term alcohol abuse, infection (such as syphilis or hepatitis B, C and D), non-alcoholic fatty liver disease (a build-up of fat in the liver (NAFLD)), problems with the surrounding body parts (such as the bile ducts that connect with the liver to transport bile), rare diseases, and genetic diseases. It is hard to detect liver disease when it starts, because the symptoms are vague and a person feels only generally tired and unwell. However, as disease becomes more serious it can show in the color of the skin, urine and stools. Serious disease is known as advanced liver disease.

What Is Liver Cirrhosis?

When the liver is injured by long-term alcohol abuse, disease or infection, scarring develops as it heals. Just like when we cut our skin and develop a scar. A scarred liver cannot work normally and a lot of scarring is life-threatening. Cirrhosis often has no symptoms until liver damage is severe. The liver damage caused by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the underlying cause is treated, further damage can be limited.

What Is Normal Blood Clotting?

Our blood contains components that balance whether it is too thick or thin. This avoids unwanted clotting (thrombosis) and unwanted bleeding (hemorrhage). Many of these are made by cells in the liver (hepatic parenchymal cells).

How Does Liver Disease Affect Normal Blood Clotting?

Liver disease results in an imbalance of these blood components, leading to a risk of unwanted clotting or bleeding. The authors describe the clotting system in patients with cirrhosis as more fragile than in healthy people because it cannot cope with problems, changes and challenges very well.

What Treatment Is Available?

The authors reported on common problems with blood clotting and recommendations for patients with liver disease. These were:

1. Deep vein thrombosis (clotting in the leg veins): The authors recommend a range of drugs depending on the type of cirrhosis and clot. These recommendations are based on guidelines from the European Association for the Study of the Liver (EASL) and the American Society of Hematology (ASH).
2. Portal vein thrombosis (clotting in the main liver vein): The authors report that it is important to treat this to give the best chance of a successful treatment through a liver transplant. They also describe various drug studies for this and stress the importance of taking anti-clotting drugs for at least 6 months and possibly life-long.
3. Atrial fibrillation (problems with the heartbeat rhythm which disrupts the pumping of blood through the body; liver cirrhosis causes a high risk of unwanted bleeding in this situation): The authors report on medical assessments that can help decisions regarding drug treatment. Again, drug choice is affected by many factors, that the authors describe in detail.

The authors report that there is a need for further information, data, and studies to better understand how to treat blood events in people with liver disease and liver cirrhosis.

Are you concerned about your liver health? The good news is that many liver diseases are preventable through lifestyle changes or vaccination. To find out more, please speak to your doctor or nurse.

Note: Two of the authors of this paper make a declaration about grants, research support, consulting fees, lecture fees, etc. received from pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest. For more detail, see the Conflict of Interest Statement at the end of the paper.