A study on changes of coagulation inhibitors and fibrinolysis inhibitors in patients with liver cirrhosis and hepatoma

Park, Chan Jeoung; Cho, Han Ik; Kim, Sang In

doi:10.3346/jkms.1991.6.1.1

Cited by 14 publications

(10 citation statements)

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“…This would provide important information for developing a protocol for perioperative hemostasis management for recipients in this part of the world, which might be different from other protocols used in overseas centers. However, the observed incidence of 25.2% for increased lupus anticoagulant in our study is in line with the increased incidence of lupus anticoagulant between 18 and 61% reported by other authors [27,28,29,30,31] for patients with hepatitis C, cirrhosis, and carcinoma. Notably, the main transplant indication in our patient population was HCV infection in 82% (41/50), even combined with HCC in 43% (18/41).…”

Section: Discussionsupporting

confidence: 79%

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

Kamel

Hassanin

Ahmed

et al. 2018

Transfus Med Hemother

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Background: Hypercoagulability can lead to serious thromboembolic events. The aim of this study was to assess the perioperative coagulation status in liver transplant recipients with a tendency to hypercoagulability. Methods: In a prospective observational study (South African Cochrane Registry 201405000814129), 151 potential liver transplant recipients were screened for thrombophilic factors from October 2014 to June 2017, and 57 potential recipients fulfilled the inclusion criterion of presenting two or more of the following thrombophilic factors: low protein C, low protein S, low anti-thrombin, increased homocystein, increased antiphospholipid IgG/IgM antibodies, increased lupus anticoagulant, and positive Factor V Leiden mutation. Seven patients were excluded from the study because they fulfilled the exclusion criteria of cancelling the liver transplantation, oral anticoagulation, or intraoperative treatment with rFVIIa. Accordingly, 50 patients were included in the final analysis. Thromboelastometry (ROTEM) (EXTEM, INTEM and FIBTEM) and conventional coagulation tests (CCT) were performed preoperatively, during the anhepatic phase, post reperfusion, and on postoperative days (POD) 1, 3 and 7. ROTEM was used to guide blood product transfusion. Heparin was infused (60-180 U/kg/day) postoperatively for 3 days and then was replaced by low-molecular-weight heparin (20 mg/12 h). Results: FIBTEM MCF significantly increased postoperatively above reference range on POD 7 despite normal fibrinogen plasma concentrations (p < 0.05). Both EXTEM and INTEM demonstrated significant changes with the phases of transplantation (p < 0.05), but with no intra- or postoperative hypercoagulability observed. INTEM CT (reference range, 100-240 s) normalized on POD 3 and 7 (196.1 ± 69.0 and 182.7 ± 63.8 s, respectively), despite prolonged aPTT (59.7 ± 18.7 and 46.4 ± 15.7 s, respectively; reference range, 20-40 s). Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) were reported in 12.0% and 2.0%, respectively, mainly after critical care discharge and with high FIBTEM MCF values in 57% on POD 3 and 86% on POD 7. Receiver operating characteristics curve analyses of FIBTEM MCF were significant predictors for thromboembolic events with optimum cut-off, area under the curve and standard error on POD 3 (>23 mm, 0.779 and 0.097; p = 0.004) and POD 7 (>28 mm, 0.706 and 0.089; p = 0.020). Red blood cells (mean ± SD, 8.68 ± 5.81 units) were transfused in 76%, fresh frozen plasma (8.26 ± 4.14 units) in 62%, and cryoprecipitate (12.0 ± 3.68 units) in 28% of recipients. None of the recipients received intraoperative platelet transfusion or any postoperative transfusion. Main transplant indication was hepatitis C infection in 82%. 76% of recipients included in this highly selected patient population showed increased lupus anticoagulant, 2% increased antiphospholipid IgG/IgM antibodies, 20% increased homocysteine, 74% decreased anti-thrombin, 78% decreased protein C, 34% decreased protein S, and 24% a positive Factor V Leiden mutation....

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Section: Discussionsupporting

confidence: 79%

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

Kamel

Hassanin

Ahmed

et al. 2018

Transfus Med Hemother

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“…It is broadly accepted that both blood clotting tests such as one-stage prothrombin time and partial thromboplastin time as well as specific clot ting factor measurements have proved to be of additional value in the diagnosis and as sessment of liver diseases [8][9][10][11], It has been reported that AT III plasma level is a good index of liver function [12], Decreased activ ity of AT III and protein C in patients with decreased hepatic synthetic function has been reported [13], In the patients with liver cell damage resulting from chronic alcohol con sumption a low level of protein C was found. Among several parameters tested a decline in protein C level was the earliest detectable and the most pronounced disturbance in the coag ulation system accompanying hepatocellular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Plasma Protein C as a Marker of Hepatocellular Damage in Alcoholic Liver Disease

Kłoczko

Mian²,

Wojtukiewicz³

et al. 1992

Pathophysiol Haemos Thromb

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The synthesis of a number of clotting factors takes place in a hepatocyte. Therefore, measurement of these factors in the blood have proved to be of additional value in the diagnosis and follow-up of liver diseases. In the present study we evaluated protein C level in the plasma of patients with liver cell damage due to chronic alcohol consumption. A decrease in plasma protein C concentration which correlated with clinical performance of the patients was found. Significant correlations between the level of protein C and antithrombin III, one-stage prothrombin time, factors VII and X and some biochemical tests reflecting liver cell damage were also stated. The obtained data indicate that plasma protein C level may constitute a useful marker of hepatocellular disease in alcoholics.

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“…A noncomprehensive list of these clinical associations includes carcinoma of the lung [6], kidney [7], breast [8], colon [8], liver [9], stomach [10], and ovary [11]. Many sporadic reports have also been published on hematological disorders that associate with aPL/APS.…”

Section: Clinical Associationsmentioning

confidence: 99%

Antiphospholipid Syndrome and Cancer

Reinstein

Shoenfeld

2007

Clinic Rev Allerg Immunol

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Thrombosis is a frequent complication of cancer that is a substantial cause of morbidity and mortality. The association of antiphospholipid antibodies (aPL) and cancer has been under investigation for several years. Recent findings suggest an increased prevalence of certain cancers in aPL-positive patients; thus, an intensive search for an occult malignancy is prompted in these patients. In addition, several studies reported on elevated levels of aPL in various malignancies; it seems, however, that aPL levels do not reflect their pathogenicity; therefore, their pathological significance in these subset of patients is still elusive. Continuing research on the association between the antiphospholipid syndrome/aPL and malignancies is important, given the potential impact on the understanding and treatment of both antiphospholipid syndrome and cancer.

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A study on changes of coagulation inhibitors and fibrinolysis inhibitors in patients with liver cirrhosis and hepatoma

Cited by 14 publications

References 1 publication

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

Plasma Protein C as a Marker of Hepatocellular Damage in Alcoholic Liver Disease

Antiphospholipid Syndrome and Cancer

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