Laboratory evidence for hypercoagulability in cirrhotic patients with history of variceal bleeding

• Published in: Thrombosis research 2019-06, Vol.178, p.41-46
• Main Authors: Rogalski, Pawel, Rogalska-Plonska, Magdalena, Wroblewski, Eugeniusz, Kostecka-Roslen, Ines, Dabrowska, Milena, Swidnicka-Siergiejko, Agnieszka, Wasielica-Berger, Justyna, Cydzik, Mariusz, Hirnle, Tomasz, Flisiak, Robert, Dabrowski, Andrzej
• Format: Article
• Language: English
• Subjects: Antithrombin; Biomarkers - blood; Esophageal and Gastric Varices - diagnosis; Female; Gastrointestinal Hemorrhage - diagnosis; Humans; Liver Cirrhosis - diagnosis; Male; Middle Aged; Procoagulant imbalance; Thrombin generation; Thromboelastometry; Thrombophilia - diagnosis; Tissue factor/factor VII
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2019.03.021

We aimed to assess the relationship between procoagulant imbalance and the occurrence of variceal bleeding in patients with liver cirrhosis. We compared the results of chromogenic assay for the functional evaluation of the Protein C anticoagulant pathway (ThromboPath®), thromboelastometry and the levels of factor VII, VIII, and antithrombin in two groups of cirrhotic patients: Group 1 (n = 25) — patients with moderate or large esophageal or gastric varices, who had never experienced acute gastrointestinal bleeding and Group 2 (n = 24) — patients with a history of variceal bleeding. Despite the differences in MELD score and the results of basic laboratory tests indicating more severe cirrhosis and suggesting a greater risk of bleeding in Group 2, the results of thromboelastometry did not differ significantly between groups. The ThromboPath® test results [ThP B: 67.8 ± 13.4 versus 59.09 ± 12.4%, p = 0.023] and factor VII level [69.04 ± 24.16 vs 53.54 ± 25.06, p = 0.032] confirmed greater plasma procoagulant activity in Group 1 compared to Group 2. However, there were no statistically significant differences in thrombin generation after activation of the protein C. Plasma of patients in Group 2 was more resistant to anticoagulation with protein C compared to Group 1 (PICI%: 65.58 ± 7.24 versus 55.64 ± 13.07%, p = 0.001). The results of our study confirm the lack of influence of coagulation disorders on the occurrence of variceal bleeding. Moreover, the results of ThromboPath® assay indicate hypercoagulability in patients with a history of variceal bleeding and more severe liver cirrhosis, compared to patients who have never bled. •Procoagulant imbalance can be easily detected in liver cirrhosis.•The hypercoagulability in liver cirrhosis does not prevent variceal bleeding.•ROTEM shows no association between variceal bleeding and coagulopathy in cirrhosis.