Whole blood thrombin generation shows a significant hypocoagulable state in patients with decompensated cirrhosis.
J Thromb Haemost
; 22(2): 480-492, 2024 Feb.
Article
em En
| MEDLINE
| ID: mdl-37866518
ABSTRACT
BACKGROUND:
Patients with cirrhosis have a normal to increased thrombin generation (TG) capacity in platelet-poor plasma (PPP). By reflecting the contribution of all circulating blood cells, whole blood (WB) TG may allow a more physiological assessment of coagulation.OBJECTIVES:
We compared WB-TG vs PPP-TG in patients with cirrhosis.METHODS:
Assessment of coagulation included routine tests, factor VIII, natural anticoagulants, PPP-TG, and WB-TG. TG assays were performed with and without thrombomodulin. Twenty-five healthy subjects were included as controls.RESULTS:
We included 108 patients (Child-Pugh A/B/C, 44/24/40). Compared with controls, patients had significantly lower platelet count, longer international normalized ratio, higher FVIII, and lower levels of protein C/S and antithrombin. Regarding thrombomodulin-modified TG assays, in compensated cirrhosis, both PPP-TG and WB-TG indicated an increased TG capacity, as reflected by an endogenous thrombin potential (ETP) significantly higher than controls. In contrast, in decompensated cirrhosis, PPP-TG indicated a hypercoagulable state with increased ETP, higher peak height, and shorter time-to-peak than controls, whereas WB-TG revealed a progressive impairment of TG kinetics and total capacity, ultimately resulting in a profound hypocoagulable state in patients with Child-Pugh C cirrhosis (ie, significant prolongation of lag time and time-to-peak with reduction of both ETP and peak height). In decompensated patients, bacterial infections and severity of anemia were associated with a further reduction of both ETP and peak height.CONCLUSION:
Compensated cirrhosis is associated with an increased TG capacity. In decompensated cirrhosis, contrary to PPP-TG, which indicates hypercoagulability, WB-TG shows a significant hypocoagulable state. The clinical value of these findings deserves further investigation.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Transtornos da Coagulação Sanguínea
/
Trombofilia
/
Cirrose Hepática
Limite:
Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article