Laboratory evidence for hypercoagulability in cirrhotic patients with history of variceal bleeding. Issue 178 (June 2019)

• Record Type: Journal Article
• Authors: Rogalski, Pawel; Rogalska-Plonska, Magdalena; Wroblewski, Eugeniusz; Kostecka-Roslen, Ines; Dabrowska, Milena; Swidnicka-Siergiejko, Agnieszka; Wasielica-Berger, Justyna; Cydzik, Mariusz; Hirnle, Tomasz; Flisiak, Robert; Dabrowski, Andrzej
• Is Part Of: Thrombosis research. Issue 178(2019)
• Page Start: 41
• Page End: 46
• Publication Date: 2019-06
• Subjects: Antithrombin -- Procoagulant imbalance -- Thrombin generation -- Thromboelastometry -- Tissue factor/factor VII; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.03.021
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Aim: We aimed to assess the relationship between procoagulant imbalance and the occurrence of variceal bleeding in patients with liver cirrhosis. Methods: We compared the results of chromogenic assay for the functional evaluation of the Protein C anticoagulant pathway (ThromboPath®), thromboelastometry and the levels of factor VII, VIII, and antithrombin in two groups of cirrhotic patients: Group 1 (n = 25) — patients with moderate or large esophageal or gastric varices, who had never experienced acute gastrointestinal bleeding and Group 2 (n = 24) — patients with a history of variceal bleeding. Results: Despite the differences in MELD score and the results of basic laboratory tests indicating more severe cirrhosis and suggesting a greater risk of bleeding in Group 2, the results of thromboelastometry did not differ significantly between groups. The ThromboPath® test results [ThP B: 67.8 ± 13.4 versus 59.09 ± 12.4%, p = 0.023] and factor VII level [69.04 ± 24.16 vs 53.54 ± 25.06, p = 0.032] confirmed greater plasma procoagulant activity in Group 1 compared to Group 2. However, there were no statistically significant differences in thrombin generation after activation of the protein C. Plasma of patients in Group 2 was more resistant to anticoagulation with protein C compared to Group 1 (PICI%: 65.58 ± 7.24 versus 55.64 ± 13.07%, p = 0.001). Conclusion: The results of our study confirm the lack of influence of coagulation disorders on the occurrence of variceal bleeding. Moreover, the results of ThromboPath® assay indicate hypercoagulability in patients with a history of variceal bleeding and more severe liver cirrhosis, compared to patients who have never bled. Highlights: Procoagulant imbalance can be easily detected in liver cirrhosis. The hypercoagulability in liver cirrhosis does not prevent variceal bleeding. ROTEM shows no association between variceal bleeding and coagulopathy in cirrhosis.