IMPAIRED BALANCE OF CLOTTING FACTORS IN LIVER CIRRHOSIS
Journal
Academic Medical Journal
Date Issued
2023
Author(s)
Dejanova, Violeta
DOI
10.53582/amj2331027v
Abstract
Liver cirrhosis (LC) has been accepted as prototype of a disease with acquired
prohemorrhagic diathesis. However, as the synthesis of all coagulant factors is affected, a
rebalanced but fragile hemostasis is maintained. With increasing disease severity, a
disproportion between levels of certain coagulants occurs that can lead to prothrombotic
tendency. We aimed to evaluate the levels of factor VIII (FVIII), protein C (PC) and their
ratio (FVIII/PC) as the main determinants of thrombin generation in patients with LC at
different stages of disease.
Fifty patients with LC were divided in three groups according to LC severity using the
Child-Turcotte-Pugh Score (CTP-A, CTP-B, CTP-C). The levels of FVIII and protein C were
measured in sodium citrate plasma on Siemens, BCS XP Blood Coagulometer. The levels of
FVIII, PC and FVIII/PC were compared between the groups and a correlation of their values
to MELD score was performed.
Plasma levels of FVIII increased with severity of the disease, with concurrent
statistically significant decrease of plasma PC levels (p=0.0008). This was accompanied with
statistically significant increase of the FVIII/PC ratio (p=0.0004) indicating hypercoagulable
state in advanced stage of the disease. A significant correlation to MELD score was identified
for PC in group CTP-B and CTP-C and for FVIII/PC ratio in group CTP-C.
As liver cirrhosis severity increases, a disproportion in plasma levels of the most
powerful determinants of thrombin generation occurs. This could be the explanation for the
observed increased risk of venous thromboembolism in patients with liver cirrhosis.
prohemorrhagic diathesis. However, as the synthesis of all coagulant factors is affected, a
rebalanced but fragile hemostasis is maintained. With increasing disease severity, a
disproportion between levels of certain coagulants occurs that can lead to prothrombotic
tendency. We aimed to evaluate the levels of factor VIII (FVIII), protein C (PC) and their
ratio (FVIII/PC) as the main determinants of thrombin generation in patients with LC at
different stages of disease.
Fifty patients with LC were divided in three groups according to LC severity using the
Child-Turcotte-Pugh Score (CTP-A, CTP-B, CTP-C). The levels of FVIII and protein C were
measured in sodium citrate plasma on Siemens, BCS XP Blood Coagulometer. The levels of
FVIII, PC and FVIII/PC were compared between the groups and a correlation of their values
to MELD score was performed.
Plasma levels of FVIII increased with severity of the disease, with concurrent
statistically significant decrease of plasma PC levels (p=0.0008). This was accompanied with
statistically significant increase of the FVIII/PC ratio (p=0.0004) indicating hypercoagulable
state in advanced stage of the disease. A significant correlation to MELD score was identified
for PC in group CTP-B and CTP-C and for FVIII/PC ratio in group CTP-C.
As liver cirrhosis severity increases, a disproportion in plasma levels of the most
powerful determinants of thrombin generation occurs. This could be the explanation for the
observed increased risk of venous thromboembolism in patients with liver cirrhosis.
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