"The ISTH SSC subcommittee on hemostatic management of patients with liver disease: goals, ambitions, and call for collaboration": comment.

We saw with interest the recent Editorial published in the journal in which Lisman et al. [[1]Lisman T. Carlin S. Gatt A. Hernandez-Gea V. Luyendyk J.P. Roberts L.N. Stanworth S.J. The ISTH SSC subcommittee on hemostatic management of patients with liver disease: goals, ambitions, and call for collaboration.J Thromb Hemost. 2023; 21: 1073-1074https://doi.org/10.1016/j.jtha.2023.02.016Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] promoted the long-awaited Subcommittee on Hemostatic Management of Patients with Liver Disease. The International Society on Thrombosis and Haemostasis should be commended for having acted on this topic, which, although in the interest of our scientific community, was left for many years to other scientific societies. However, for the sake of accuracy, we wish to mention that the chronology of events reported in the introduction and that led to a better understanding of the coagulopathy of cirrhosis and the new concept of rebalanced hemostasis, has not been properly reported. As a matter of fact, the first experimental evidence of rebalanced coagulation was provided by our group in an article published in Hepatology in 2005 [[2]Tripodi A. Salerno F. Chantarangkul V. Clerici M. Cazzaniga M. Primignani M. Mannuccio Mannucci P. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests.Hepatology. 2005; 41: 553-558Crossref PubMed Scopus (552) Google Scholar], in which we included thrombomodulin in the assay system for thrombin generation and showed for the first time that thrombin generation in patients with cirrhosis is similar to that in healthy subjects, provided that it is assessed using laboratory procedures responsive to both procoagulants and anticoagulants. This was (and still is) not possible with the prothrombin time and congener tests because they are responsive to procoagulant and not to anticoagulant factors [[3]Tripodi A. Caldwell S.H. Hoffman M. Trotter J.F. Sanyal A.J. Review article: the prothrombin time test as a measure of bleeding risk and prognosis in liver disease.Aliment Pharmacol Ther. 2007; 26: 141-148Crossref PubMed Scopus (166) Google Scholar,[4]Tripodi A. Chantarangkul V. Mannucci P.M. Acquired coagulation disorders: revisited using global coagulation/anticoagulation testing.Br J Haematol. 2009; 147: 77-82Crossref PubMed Scopus (106) Google Scholar]. That is why they are prolonged in plasma from patients with cirrhosis but do not represent the balance of coagulation occurring in vivo. A year later, Lisman et al. [[5]Lisman T. Bongers T.N. Adelmeijer J. Janssen H.L. de Maat M.P. de Groot P.G. Leebeek F.W. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity.Hepatology. 2006; 44: 53-61Crossref PubMed Scopus (471) Google Scholar] reported an article showing that thrombocytopenia, which is the hallmark of cirrhosis, is counterbalanced by increased levels of the adhesive protein von Willebrand factor, another typical feature of cirrhosis. Many other articles on the topic came later, such as 2 important review articles authored by Lisman and Porte [[6]Lisman T. Porte R.J. Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences.Blood. 2010; 116: 878-885Crossref PubMed Scopus (461) Google Scholar] in Blood and by Tripodi and Mannucci [[7]Tripodi A. Mannucci P.M. The coagulopathy of chronic liver disease.N Engl J Med. 2011; 365: 147-156Crossref PubMed Scopus (1039) Google Scholar] in New England Journal of Medicine (only the first being quoted in the present editorial). We believe that the articles by Tripodi et al. [[2]Tripodi A. Salerno F. Chantarangkul V. Clerici M. Cazzaniga M. Primignani M. Mannuccio Mannucci P. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests.Hepatology. 2005; 41: 553-558Crossref PubMed Scopus (552) Google Scholar] and Lisman et al. [[5]Lisman T. Bongers T.N. Adelmeijer J. Janssen H.L. de Maat M.P. de Groot P.G. Leebeek F.W. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity.Hepatology. 2006; 44: 53-61Crossref PubMed Scopus (471) Google Scholar] should be specifically acknowledged and quoted because they are seminal papers describing the progress achieved in the understanding of the new concept, regarding the coagulopathy of cirrhosis. In conclusion, the history of events reported in the Editorial by Lisman et al. [[5]Lisman T. Bongers T.N. Adelmeijer J. Janssen H.L. de Maat M.P. de Groot P.G. Leebeek F.W. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity.Hepatology. 2006; 44: 53-61Crossref PubMed Scopus (471) Google Scholar] should have been revised to give credit to the article by Tripodi et al. [[2]Tripodi A. Salerno F. Chantarangkul V. Clerici M. Cazzaniga M. Primignani M. Mannuccio Mannucci P. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests.Hepatology. 2005; 41: 553-558Crossref PubMed Scopus (552) Google Scholar] for providing evidence of rebalanced coagulation and the article by Lisman et al. [[5]Lisman T. Bongers T.N. Adelmeijer J. Janssen H.L. de Maat M.P. de Groot P.G. Leebeek F.W. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity.Hepatology. 2006; 44: 53-61Crossref PubMed Scopus (471) Google Scholar] for providing evidence of rebalanced primary hemostasis simply because they have been instrumental for understanding the new concepts of the coagulopathy of cirrhosis that will be the focus of interest of the new International Society on Thrombosis and Haemostasis Subcommittee. A.T. conceived the letter and wrote the manuscript. P.M. reviewed the letter and approved the content. There are no competing interests to disclose.