Document Detail


An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis.
MedLine Citation:
PMID:  19706293     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Patients with cirrhosis have an increased tendency to develop thromboses despite the longer coagulation times of their plasma, compared with that of healthy individuals. We investigated whether plasma from cirrhotic patients has an imbalance of pro- vs anti-coagulation factors. METHODS: We analyzed blood samples from 134 cirrhotic patients and 131 healthy subjects (controls) for levels of pro- and anti-coagulants and for thrombin generation in the presence or absence of thrombomodulin (the main physiologic activator of the protein C anticoagulant pathway). RESULTS: The median ratio of thrombin generation (with/without thrombomodulin) was higher in patients (0.80; range, 0.51-1.06) than controls (0.66; range, 0.17-0.95), indicating that cirrhotic patients are resistant to the action of thrombomodulin. This resistance resulted in greater hypercoagulability of plasma from patients of Child-Pugh class C than of class A or B. The hypercoagulability of plasma from patients of Child-Pugh class C (0.86; range, 0.70-1.06) was slightly greater than that observed under the same conditions in patients with congenital protein C deficiency (0.76; range, 0.60-0.93). Levels of factor VIII, a potent pro-coagulant involved in thrombin generation, increased progressively with Child-Pugh score (from Child-Pugh class A to C). Levels of protein C, one of the most potent naturally occurring anti-coagulants, showed the opposite trend. CONCLUSIONS: The hypercoagulability of plasma from patients with cirrhosis appears to result from increased levels of factor VIII and decreased levels of protein C-typical features of patients with cirrhosis. These findings might explain the risk for venous thromboembolism in patients with chronic liver disease.
Authors:
Armando Tripodi; Massimo Primignani; Veena Chantarangkul; Alessandra Dell'Era; Marigrazia Clerici; Roberto de Franchis; Massimo Colombo; Pier Mannuccio Mannucci
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Publication Detail:
Type:  Journal Article     Date:  2009-08-23
Journal Detail:
Title:  Gastroenterology     Volume:  137     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-07     Completed Date:  2009-12-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2105-11     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine and Medical Specialties, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy. armando.tripodi@unimi.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Biological Markers / blood
Blood Coagulation*
Case-Control Studies
Factor VIII / metabolism
Female
Humans
Liver Cirrhosis / blood*,  complications
Male
Middle Aged
Protein C / metabolism
Severity of Illness Index
Thrombin / metabolism*
Thrombomodulin / blood
Thrombophilia / blood,  etiology*
Thrombosis / blood,  etiology*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Protein C; 0/Thrombomodulin; 9001-27-8/Factor VIII; EC 3.4.21.5/Thrombin

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