Clinical Significance of Haemostatic Tests in Chronic Liver Disease

Saray, Aida; Mesihović, Rusmir; Vanis, Nenad; Gornjakovic, Srdjan; Prohić, Džanela

doi:10.5455/medarh.2012.66.231-235

Cited by 11 publications

(11 citation statements)

References 34 publications

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“…In addition, those with cirrhosis were specifically selected for their higher liver disease severity, due to their associated complications such as portosystemic shunts which significantly increases mortality than those without cirrhosis or CLD (Simón-Talero et al, 2018 ). Several reports also confirm the utility of our approach, dividing participants into those without liver disease, with non-cirrhotic liver disease, and with cirrhosis, to classify liver disease severity (Saray et al, 2012 ; Montomoli et al, 2013 ).…”

Section: Methodssupporting

confidence: 59%

Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

2018

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Background: Acarbose has been deemed contraindicated in diabetic patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD), but such use is not uncommon. We tested whether this concept hold true in this population with different background hepatic diseases.Methods: All incident diabetic patients (n = 2,036,531) with stage 5 CKD/ESRD were enrolled from Taiwan between 2017 and 2013 and divided into those without chronic liver disease (CLD), with CLD but without cirrhosis, and those with cirrhosis. Among each group, acarbose users, defined as cumulative use >30 days within the preceding year, were propensity-score matched 1:2 to non-users. Our main outcome was the development of liver injury events during follow-up.Results: Acarbose users did not exhibit an increased incidence of liver injury during follow-up compared to non-users (hazard ratio and 95% confidence interval, 1.04 [0.88–1.25], 0.97 [0.61–1.56], and 0.71 [0.33–1.54] among those without CLD, with CLD but without cirrhosis, and those with cirrhosis, respectively), after adjusting for demographic profiles, comorbidities, potentially hepatotoxic medication use, and diabetic severity.Conclusions: The incidence of liver injury did not increase significantly among diabetic acarbose users with severe renal insufficiency than non-users, regardless of the presence or absence of chronic liver disease. Our findings support the renaissance of acarbose as a useful adjunct in diabetic patients with stage 5 and 5D chronic kidney disease.

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Section: Methodssupporting

confidence: 59%

Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

2018

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“…31 Therefore, they are a good indicator of its evaluation. 32,33 In this sense, the high levels of protein C in PAF could be interpreted as indicative of enhanced liver function and, respectively, enhanced protein C biosynthesis and secretion in the early hours of the rhythm disorder. The formation of ''pure'' groups in terms of comorbidities and medications affecting hemostasis is an important prerequisite for this claim (see Table 1).…”

Section: Discussionmentioning

confidence: 99%

Decreased Activity of the Protein C Anticoagulant Pathway in the Early Hours of Paroxysmal Atrial Fibrillation

Negreva

Georgiev

Vitlianova

2016

Clin Appl Thromb Hemost

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Background: Increased coagulation activity has been established in paroxysmal atrial fibrillation (PAF), but data on the anticoagulant system are scarce. Purpose: To examine the protein C anticoagulant pathway in the early hours of the disease. Materials and Methods: Fifty-one patients (26 men and 25 women; mean age 59.84 + 1.60 years) and 52 controls (26 men and 26 women; mean age 59.50 + 1.46 years) were selected for the study. Protein C antigen and its activity, total protein S, free protein S and its activity, soluble forms of endothelial protein C receptor (sEPCR), and thrombomodulin (sTM) were examined in the plasma. Results: The indicators were studied in patients between the 2nd and the 24th hour after the onset of arrhythmia. Levels of protein C were significantly elevated in patients compared to controls (111.40% + 6.66% vs 94.83% + 4.47%; P ¼ .039). Protein C activity showed significant reduction in PAF (73.13% + 5.80% vs 103.3% + 3.80%; P < .001). Total protein S levels did not differ significantly (108.20% + 4.07% vs 102.40% + 3.65%; P ¼ .30). Free protein S (76.81% + 6.01% vs 122.10% + 3.97%; P < .001) and its activity (71.39% + 6.27% vs 119.50% + 6.54%; P < .001) were reduced in patients. Higher levels of sEPCR (203.10 + 10.33 vs 133.10 + 7.37 ng/mL; P < .001) and sTM (6.50+0.40 vs 4.48+0.28 ng/mL; P < .001) were measured in PAF. Conclusion: Protein C activity is reduced still in the first hours (until the 24th hour) of PAF clinical manifestation, determining reduced activity of the anticoagulant pathway as a whole. The established low levels of free protein S and its activity as well as low sEPCR and sTM levels are a possible explanation of the changes in protein C activity.

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“…Advanced liver disease is commonly associated with variable coagulation disorders including marked decrease in procoagulant factors [5][6][7] as well as their anticoagulant counterparts, namely, protein C (PC) and antithrombin III (AT), due to impaired synthesis. [8][9][10][11] Despite the fact that cirrhosis is characterized by a prolongation of conventional coagulation tests, clinical observations have shown that these patients are not protected of thrombotic events. Moreover, recent in vitro studies have even shown a procoagulant imbalance in patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Protein C Deficiency in Chronic Hepatitis C

Saray

Mesihović

Vanis

et al. 2016

Clin Appl Thromb Hemost

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There is accumulating evidence that the coagulation system is involved in the process of fibrogenesis in chronic liver disease. Recent studies postulated a possible connection between plasmatic hypercoagulability and progression of fibrosis. The aim of the study was to investigate disorders of the coagulation system in patients with chronic hepatitis C having different extent of hepatic fibrosis well defined by liver histology. A total of 62 patients with chronic hepatitis C were recruited and categorized into 2 groups according to their histological fibrosis stage : mild/moderate fibrosis group (F0-F3 group, n = 30) and extensive fibrosis/cirrhosis group (F4-F6 group, n = 32). The control group consisted of 31 healthy individuals. The following hemostatic assays were evaluated: antithrombin III (AT), protein C (PC) activity, activated partial thromboplastin time, prothrombin time, plasma fibrinogen as well as conventional liver function test. The PC level exhibited a significant reduction in both patient groups when compared to the normal control group (89.25% ± 10.05% and 48.33% ± 15.86% vs 111.86 ± 10.90; P < .001 and P < .001). The PC was found to be the strongest associated factor to histological fibrosis stage (r = -.834; P < .0001). Univariate and multivariate analysis showed that AT (P = .003) and PC (P = .0001) were the most important factors associated with advanced fibrosis. The PC (P = .001) was found to be the only predictor of mild fibrosis. In conclusion, PC deficiency occurs in an early stage of liver fibrosis. The severity of deficiency is proportional to extent of fibrosis. The PC may have a key role in linking hypercoagulability with hepatic fibrogenesis in chronic liver disease.

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Clinical Significance of Haemostatic Tests in Chronic Liver Disease

Cited by 11 publications

References 34 publications

Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

Decreased Activity of the Protein C Anticoagulant Pathway in the Early Hours of Paroxysmal Atrial Fibrillation

Protein C Deficiency in Chronic Hepatitis C

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