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World J Hepatol. Oct 27, 2026; 18(10): 124763
Published online Oct 27, 2026. doi: 10.4254/wjh.124763
Published online Oct 27, 2026. doi: 10.4254/wjh.124763
Imbalance of the coagulation-anticoagulation-fibrinolytic system: Pathogenesis and therapeutic approaches in progressive liver injury
Yong-Jing Tang, Chen-Xi Wang, Yun Wen, Ren-Dong Tian, Dian-Wei Wan, Kang-Yan Liu, Yu-Xin Xie, Yi-Huai He, Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Zong-Qin Pan, Department of Infectious Diseases, People’s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Kaili 556000, Guizhou Province, China
Jin Ao, Department of Interventional, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Co-first authors: Yong-Jing Tang and Chen-Xi Wang.
Co-corresponding authors: Jin Ao and Yi-Huai He.
Author contributions: Tang YJ and Wang CX were responsible for collecting pathophysiological data related to the coagulation system, contributed equally to this work, qualified as the co-first authors of the paper; Wen Y and Tian RD collected pathophysiological data related to the anticoagulation system; Wan DW and Pan ZQ collected pathophysiological data related to the fibrinolytic system; Liu KY and Xie YX were responsible for collecting existing therapeutic approaches for hemostasis and anticoagulation; Tang YJ, Wang CX, and Pan ZQ organized and analyzed the collected data; He YH, Ao J, and Tang YJ conceived and designed the content of the article; Tang YJ and Wang CX wrote the initial paper; He YH, Ao J, Tian RD, Xie YX, and Wan DW revised the paper; He YH had primary responsibility for the final content; and all authors read and approved the final manuscript; Ao J and He YH played important and indispensable roles in the manuscript preparation as the co-corresponding authors.
AI contribution statement: The authors declare that no AI tools were used in any part of the manuscript preparation process, including but not limited to manuscript writing, text editing, data collection, data analysis, and the preparation of images or graphical elements. All content of the manuscript was independently completed by the authors, who are fully responsible for the authenticity, accuracy, and integrity of all information presented in the paper.
Supported by Science and Technology Planning Projects of Guizhou Province, No. QKHJC-MS(2025)384 and No. QKHJC-MS(2025)392; Health Research Project of Guizhou Province, No. gzwkj2024-103 and No. gzwkj2024-324; Scientific Research Project of the Guizhou Provincial Bureau of Traditional Chinese Medicine, No. QZYY-2023-021; the Chinese Foundation for Hepatitis Prevention and Control Muxin Research Fund of CHB, No. MX202404; and Beijing Liver and Gallbladder Mutual Aid Public Welfare Foundation Artificial Liver Special Fund, No. iGandanF-1082024-RGG018.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Corresponding author: Yi-Huai He, MD, Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi 563000, Guizhou Province, China. 993565989@qq.com
Received: June 24, 2026
Revised: August 13, 2026
Accepted: September 22, 2026
Published online: October 27, 2026
Processing time: 119 Days and 2.7 Hours
Revised: August 13, 2026
Accepted: September 22, 2026
Published online: October 27, 2026
Processing time: 119 Days and 2.7 Hours
Core Tip
Core Tip: During the progression of liver injury, an imbalance in the coagulation-anticoagulation-fibrinolysis cascade results in a complex hemostatic state: Systemic hypocoagulability with bleeding tendency vs intrahepatic and portal hypercoagulability with thrombotic risk. This dichotomy drives microcirculatory dysfunction, portal vein thrombosis, and disease aggravation. This review summarizes the dynamics of these changes, their pathological implications, and therapeutic interventions, offering a theoretical backing for the management of liver injury.