Hypercoagulability in acute esophageal variceal bleeding

Bleeding in Cirrhotic Patients: A Precipitating Factor due to Intravascular Coagulation or to Hepatic Failure?

“…The very low plasma level of factor VIII:C in the 5 patients who died seems to confirm the presence of DIC. Post-DIC bleeding can therefore also be fatal for pa tients with moderate chronic liver disease [13,14], It remains to be seen whether in advanced hepatic cirrhosis, hemodynamic changes [2,8,22], with the ensuing variations in splanchnic blood flow and in the tension of esophageal varices [4], lead to DIC or whether it is DIC which is responsible for bleeding and the following fatal hemody namic changes. Thus, since DIC seems to be of importance in the appearance and severity of bleeding, even during chronic liver dis ease, patients with hepatic failure should be monitored with predictive hypercoagulabil ity and/or DIC tests.…”

“…Therefore because of the necrosis of the liver cells, the hemodynamic changes due to ex panded collaterals in the presence of im paired clearance of activated factors could trigger off disseminated intravascular coagu lation (DIC), inducing bleeding in liver pa tients [21,22,28]. In acute hepatic failure the incidence and magnitude of intravascular co agulation and its relation to the severity of bleeding and prognosis has been assessed [13], Subsequently, in hepatic cirrhosis and in other diseases with liver involvement, evi dence of the relationship between a hypercoagulable state and a significant increase or decrease of most significant parameters in this condition has been reported [1,10,14,18,27], To verify the relationship of bleeding to either a hypercoagulability condition or the severity of hepatic failure, we evaluated fac tor VIII:C (F VIII:C), factor VIIIR:AG (F VIIIR:AG), factor VIII AG/C ratio (F VIII AG/C) and serum fibrin-fibrinogen degrada tion products (FDP) in a group of patients with advanced liver cirrhosis.…”