Imbalance of the coagulation-anticoagulation-fibrinolytic system: Pathogenesis and therapeutic approaches in progressive liver injury

Table 2 Summary of blood products and/or pharmacological recommendations for thrombosis in cirrhosis

	Choice of agent	Statement	Limitations
Anticoagulation agents	LMWH	Monitor anti-FXa activity; evaluate anticoagulation efficacy	Short half-life; subcutaneous injection
	Warfarin	Inhibits vitamin K-dependent coagulation factor synthesis	Monitor INR to guide anticoagulation therapy; high bleeding risk
	Rivaroxaban	Inhibits FXa	Contraindicated or not recommended in severe hepatic impairment (Child-Pugh class C)
Antiplatelet agents	Aspirin or aspirin-magnesium-aluminum	Inhibits COX-1; blocks thromboxane A₂ formation. Suppresses platelet aggregation	Irritation of the gastrointestinal mucosa
	Clopidogrel or ticagrelor	Irreversibly inhibits the P2Y12 receptor on platelets and exerts antithrombotic activity	Risk of bleeding events

LMWH: Low-molecular-weight heparin; FXa: Activated factor X; INR: International normalized ratio; COX-1: Cyclooxygenase-1; P2Y12: Purinergic receptor Y12.