Procoagulant versus anticoagulant factors in cirrhotic patients

Bokl, M. A. El; Shawky, A.; Riad, George S.; Fattah, Hisham S. Abdel; Shalaby, Hassan; Nady, Ahmed; Khattab, Dina

doi:10.1016/j.ajg.2014.08.003

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…In one study, Tripodi et al, showed that factor VIII increases with higher Child-Pugh score and may be up to 200% greater in those with Child-Pugh C cirrhosis [ 13 ]. El Boki et al found similar results, further validating these findings [ 14 ]. Tang et al, found that Protein C, Protein S and antithrombin levels were progressively decreased with increasing severity of Child-Pugh class [ 15 ].…”

Section: Coagulopathy Vs Thrombosis In Cirrhosissupporting

confidence: 77%

Hemostasis, bleeding and thrombosis in liver disease

Flores¹,

Trivedi²,

Robson³

et al. 2017

J Transl Sci

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The presence of cirrhosis poses an increased risk of both thrombosis and bleeding in individuals with chronic liver disease. This duality is a result of a dynamic disequilibrium between procoagulant and anticoagulant states in individuals with cirrhosis. The mechanism of this imbalance in cirrhosis remains unclear. It is known that the progression of cirrhosis leads to decreased synthetic function and a concurrent lack of natural anticoagulants. Other proposed mechanisms contributing to this hemostatic imbalance include decreased platelet production, increased platelet destruction from hypersplenism, decreased synthesis of Vitamin K-dependent and independent clotting factors and anticoagulant factors, and alterations in purinergic signaling pathways.Given the current state of flux in our understanding of bleeding and thrombophilia in cirrhosis, the recommendations for treatment of these conditions are still evolving.We provide a current update on the proposed pathophysiology of altered hemostasis and thrombophilia in cirrhosis. We discuss recent studies in portal vein thrombosis (PVT) and venous thromboembolism (VTE), which are the common thrombotic consequences of cirrhosis, resulting in substantive morbidity and mortality. To address these, we discuss new prophylactic interventions and current treatment options to manage the heightened risk of thrombosis in cirrhosis, while limiting hemorrhagic complications.

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Section: Coagulopathy Vs Thrombosis In Cirrhosissupporting

confidence: 77%

Hemostasis, bleeding and thrombosis in liver disease

Flores¹,

Trivedi²,

Robson³

et al. 2017

J Transl Sci

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“…In two studies (10,21), the diagnosis for VTE was based on duplex ultrasound, computed tomography and/or angiography, while the diagnosis of cirrhosis was based on documented past medical history. No information on the diagnosis of VTE and cirrhosis was reported in two studies (20,22).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Only one study (12) reported data on the prevalence of smoking habit (1.3 %), diabetes mellitus (6.4 %), obesity (0.5 %), and hyperlipidaemia (18.2 %). One study (22) provided information on the prevalence of pregnancy (0 %) and exposure to hormonal therapy (0 %), and one (21) on the prevalence of prolonged immobilisation (72 %). No study provided data on the prevalence of CRF.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The analysis of the 11 studies (15 datasets) (10)(11)(12)(20)(21)(22)(23)(24)(25)(26)(27) showed that the absolute risk of VTE was 3.7 % (95 %CI: 0.7-18.2) in 695,012 cirrhotic patients and 1.8 % (95 %CI: 0.3-9.1) in 1,494,660 non-cirrhotic controls (OR: 1.703; 95 %CI: 1.333, 2.175; p<0.0001, ▶ Figure 1), with an attributable risk of 51.3 %. Heterogeneity among these studies was statistically significant (I 2 =95.6 %; p<0.0001) and it was not reduced after excluding one study at time.…”

Section: Primary Analysis: Venous Thromboembolism (Vte)mentioning

confidence: 99%

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The risk of venous thromboembolism in patients with cirrhosis

Ambrosino¹,

Tarantino²,

Minno³

et al. 2017

Thromb Haemost

171

137

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Some studies suggest that patients with cirrhosis have an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). Unfortunately, available data on this association are contrasting. It was the objective of this study to perform a systematic review and meta-analysis of literature to evaluate the risk of venous thromboembolism (VTE) associated with cirrhosis. Studies reporting on VTE risk associated with cirrhosis were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Eleven studies (15 data-sets) showed a significantly increased VTE risk in 695,012 cirrhotic patients as compared with 1,494,660 non-cirrhotic controls (OR: 1.703; 95 %CI: 1.333, 2.175; P<0.0001). These results were confirmed when specifically considering the risk of DVT (7 studies, OR: 2.038; 95 %CI: 1.817, 2.285; P<0.0001) and the risk of PE (5 studies, OR: 1.655; 95 %CI: 1.042, 2.630; p=0.033). The increased VTE risk associated with cirrhosis was consistently confirmed when analysing nine studies reporting adjusted risk estimates (OR: 1.493; 95 %CI: 1.266, 1.762; p<0.0001), and after excluding studies specifically enrolling populations exposed to transient risk factors for VTE (OR: 1.689; 95 %CI: 1.321, 2.160; p<0.0001). Meta-regression models suggested that male gender may significantly impact on the risk of VTE associated with cirrhosis. Results of our meta-analysis suggest that cirrhotic subjects may exhibit an increased risk of VTE. This should be considered to plan specific prevention strategies in this clinical setting.

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“…The association of cirrhosis and procoagulant imbalance has been well‐documented and more recently a correction of the procoagulant imbalance, likely related to fibrosis reduction, has been reported after viral eradication following treatment with DAA in patients with cirrhosis. Our study adds further information on this topic, providing evidence that CHC patients, even in the presence of mild liver damage, as documented by low mean values of ALT, LMS, and fibrosis scores, show signs of procoagulant imbalance.…”

Section: Discussionmentioning

confidence: 99%

Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis

Sigon

D’Ambrosio

Clerici

et al. 2019

Liver International

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Background & Aims:Patients with chronic HCV infection besides hepatitis often present cardiovascular damage, the pathogenesis of which is not defined. In chronic liver diseases, including NAFLD and cirrhosis, a procoagulant imbalance, potentially responsible for atherosclerosis has been reported. We aimed at evaluating whether a procoagulant imbalance is present also in non-cirrhotic patients with HCV infection and whether the procoagulant imbalance correlates with cardiovascular damage.The correlation between the procoagulant imbalance, coexisting steatosis, and liver fibrosis was analysed.Methods: From 2014 to 2018, 393 subjects (205 patients with chronic HCV infection from two liver units and 188 controls) were enrolled. Metabolic, cardiovascular, liver assessment and coagulation parameters-procoagulants (FII and FVIII) and anticoagulants (antithrombin and protein C [PC]), endogenous thrombin potential (ETP), peak-thrombin and their ratios (with/without thrombomodulin)-were determined. Results:The procoagulant imbalance (defined as high FVIII, FVIII/PC ratio, ETP-ratio and peak-thrombin-ratio (with/without thrombomodulin)) was significantly higher in patients with chronic HCV than controls. Steatosis was detected in 87 patients (42%).No difference in coagulation imbalance, carotid and cardiac parameters and severity of liver fibrosis was observed in patients with or without steatosis, despite the latter had less severe metabolic alterations. The FVIII/PC ratio was independently associated with carotid intima-media thickness (coefficient 0.04, 95% CI 0.002-0.07, P = .04) and liver fibrosis (coefficient 0.64, 95% CI 0.37-0.92, P < .0001). Conclusion: Patients with HCV infection, even in the absence of cirrhosis have a procoagulant-imbalance that possibly plays a role in increasing the risk of cardiovascular disease and progression of fibrosis. How to cite this article: Sigon G, D'Ambrosio R, Clerici M, et al. Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis. Liver

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Procoagulant versus anticoagulant factors in cirrhotic patients

Cited by 7 publications

References 19 publications

Hemostasis, bleeding and thrombosis in liver disease

Hemostasis, bleeding and thrombosis in liver disease

The risk of venous thromboembolism in patients with cirrhosis

Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis

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