New Nordic | Active Liver Tablets | Pack of 2 x 30s

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Turco L, Schepis F, Villa E. The role of anticoagulation in treating portal hypertension. Curr Hepatol Rep. 2018;17:200–8. The activation of hepatic stellate cells (HSC) is the key pathogenic mechanism of hepatic fibrogenesis. Experimental animal models support a biological link between coagulation and fibrosis showing that thrombin and FXa can activate HSC [ 62, 63] and, conversely, their inhibition by anticoagulants may prevent or reduce fibrogenesis [ 57]. In studies done in 2016 and 2018 of people with nonalcoholic fatty liver disease, artichoke leaf reduced markers of liver damage compared with placebo. However, the clinical benefits of artichoke leaf supplementation remain to be seen. Dandelion root A recent study, using data from a large healthcare utilization database in the United States, has shown a lower rate of hospitalizations for DILI in patients on DOACs as compared to those on warfarin (5 vs. 9 per 1000 person-years) among a cohort of 113,717 patients with NVAF receiving a first-time oral anticoagulant prescription (50% warfarin and 50% DOACs). Among DOACs, dabigatran had the lowest relative risk of hospitalization owing to DILI [ 113]. History of hepato-biliary disease, alcoholism, kidney disease, heart failure, anemia and cancer are risk factors for hospitalization owing to DILI [ 113].

Mantovani A, Byrne CD, Bonora E, Targher G. Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: a meta-analysis. Diabetes Care. 2018;41:372–82.Finally, two previously published metanalyses have evaluated the use of warfarin and DOACs in cirrhotic patients including some of the above reported studies. The first including 19,798 cirrhotic patients with AF from seven cohort studies, two of which comparing DOACs vs warfarin [ 81, 83], had two main findings: (a) the use of warfarin was associated with a lower risk of stroke compared with no anticoagulation (HR 0.58) without a significantly increased bleeding risk (HR 1.45), (b) the use of DOACs was associated with a lower risk of bleeding among AF patients with cirrhosis (OR 1.93) [ 95]. The second, including 447 cirrhotic patients from five studies [ 77, 79, 81, 82, 84] undergoing anticoagulant therapy (DOACs vs warfarin/LMWH) owing to various indications, found that patients treated with DOACs had no significantly increased risk of all-cause bleeding [relative risk (RR) 0.72] and major bleeding (OR 0.46) as compared to those who received traditional anticoagulants [ 96]. Updated meta-analyses including the most recent data from large Asian population studies are eagerly awaited. In cirrhotic patients, pro-hemorrhagic and prothrombotic drivers co-exist. Pro-hemorrhagic conditions include: (a) reduced plasma levels of coagulation factors synthesized by the liver [fibrinogen, factor (F)II, FV, FVII, FIX, FX, FXI, and FXII] reflected by prolonged PT and activated partial thromboplastin time (aPTT) (b) thrombocytopenia due to splenic sequestration and reduced thrombopoietin synthesis and (c) increased fibrinolysis secondary to elevated levels of tissue plasminogen activator, reduced levels of plasmin inhibitor and thrombin-activatable fibrinolysis inhibitor [ 17]. Conversely, pro-thrombotic conditions include: (a) decreased endogenous anticoagulants synthesized by the liver: protein C, protein S and antithrombin (AT) (b) increased pro-coagulant endothelial-derived FVIII (c) increased platelet aggregation due to increased endothelial-derived von Willebrand factor (vWF) and reduced ADAMTS13, a natural inhibitor of vWF activity (d) reduced hepatic synthesis of plasminogen causing hypo-fibrinolysis [ 17]. Gallagher C, Sanders P, Wong CX. Anticoagulation for atrial fibrillation in cirrhosis of the liver: are low-dose non-vitamin K oral anticoagulants a reasonable alternative to warfarin? J Am Heart Assoc. 2019;8:e012102. Journal of Human Nutrition and Dietetics: “Detox diets for toxin elimination and weight management: a critical review of the evidence.” Kunk PR, Collins H, Palkimas S, Intagliata NM, Maitland HS. Direct oral anticoagulants in patients with cirrhosis appear safe and effective. Blood. 2016;128:3827.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an age-dependent global prevalence of 1–3% in the adult population, exceeding 15% in people aged 80 years and over [ 1, 2]. It is estimated that subjects over 65 years affected by AF in Europe will increase by 89% from 7.6 to 14.4 million within the next 40 years, with prevalence rising from 7.8 to 9.5% [ 2]. Moreover, AF is significantly associated with an increased risk of thromboembolic events [5-times higher risk of stroke], hospitalization and mortality [ 1, 2]. Anti-Xa levels are positively correlated with AT levels, which are reduced in cirrhotic patients [ 18, 20, 23, 24]. Therefore, the anti-Xa assay cannot be used to monitor AT-dependent anticoagulant drugs (LMWH/UFH) in patients with cirrhosis, given that it substantially underestimates drug levels. Conversely, the direct FXa and thrombin (FIIa) inhibitors can be monitored through the respective anti-Xa and anti-IIa assays in cirrhotic patients [ 19]. AF and VTE in Cirrhosis of Various Etiology D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.Aside from DVT/PE, a major issue for patients affected by CLD is splanchnic vein thrombosis, including mesenteric, portal and hepatic vein thrombosis [ 32]. Portal vein thrombosis (PVT) is the most common VTE event in cirrhosis with a prevalence ranging from nearly 1% in compensated to 8–25% in decompensated cirrhosis [ 34, 35]. Mechanistic factors involved in the development of PVT in cirrhotic patients are likely to be multi-factorial. Prior VTE, thrombophilia, low portal vein flow velocity, malignancy, intra-abdominal infection, and recent surgery all increase the risk for PVT [ 32]. Of note, patients with cirrhosis who develop PVT and have no other history of clotting do not require a hypercoagulable workup [ 13]. The clinical presentation is variable and stability, regression, or resolution appear more common than clot progression [ 36]. Anticoagulation with LMWH appears safe and effective for PVT in cirrhosis [ 13, 37, 38]. AF and VTE in the NAFLD Spectrum Our understanding of the hemostatic balance in liver disease has progressed dramatically over the last decades. The prolongation of prothrombin time (PT)/international normalized ratio (INR) commonly found in advanced liver disease was traditionally considered protective from thrombo-embolic events. However, accumulating evidence has dismantled the theory of “auto-anticoagulation” in cirrhosis showing a high risk of VTE in cirrhotic patients, despite PT/INR values [ 14, 15, 16].

Though dandelion has been used to treat liver ailments, the evidence of its benefits is scarce. Much more research is needed to determine whether it’s safe and effective for this purpose. Other ingredients Ballestri S, Lonardo A, Bonapace S, Byrne CD, Loria P, Targher G. Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease. World J Gastroenterol. 2014;20:1724–45.Active Liver er et kosttilskud som bidrager til vedligeholdelse af en normal leverfunktion. Tabletterne er specielt velegnet til dig, som lever et ernæringsmæssigt usundt liv med for meget fedt. Mantovani A. Nonalcoholic fatty liver disease (NAFLD) and risk of cardiac arrhythmias: a new aspect of the liver-heart axis. J Clin Transl Hepatol. 2017;5:134–41.

Rambaldi A, et al. (2007). Milk thistle for alcoholic and/orhepatitis B or C virus liver diseases. DOI: Verrijken A, Francque S, Mertens I, Prawitt J, Caron S, Hubens G, et al. Prothrombotic factors in histologically proven nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2014;59:121–9. Chokesuwattanaskul R, Thongprayoon C, Bathini T, et al. Efficacy and safety of anticoagulation for atrial fibrillatiThe main person in charge of your care will be a doctor who specialises in either the digestive system (gastroenterologist) or the liver (hepatologist). They may write you a care plan, which sets out what appointments you have and who else is in your Multidisciplinary Team (MDT). If you have kidney disease, a cleanse that includes large amounts of juice can make your illness worse. Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387–94. Dandelion has also been considered a natural remedy for various conditions. More study is needed to prove that it works.