Cirrhosis patients have a coagulopathy that is associated with decreased clot formation capacity

Summary Background The coagulopathy in cirrhosis is associated with thrombosis and bleeding. Objectives To gain better insights into the coagulopathy in patients with cirrhosis, we evaluated plasma thrombin generation and whole blood clot formation in a cross‐sectional study. Methods Blood was colle...

Full description

Saved in:
Bibliographic Details
Published in:Journal of thrombosis and haemostasis 2014-10, Vol.12 (10), p.1647-1657
Main Authors: Kleinegris, M.‐C., Bos, M. H. A., Roest, M., Henskens, Y., Cate‐Hoek, A., Van Deursen, C., Spronk, H. M. H., Reitsma, P. H., De Groot, P. G., Cate, H., Koek, G.
Format: Article
Language:English
Subjects:
Adult
Aged
Automation
Blood Coagulation
Blood Coagulation Disorders - complications
Blood Platelets - metabolism
Calibration
Case-Control Studies
cirrhosis
Cross-Sectional Studies
Factor IXa - chemistry
Factor VIIa - chemistry
Factor X - chemistry
Female
Fibrinolysis
Fibrosis - complications
hemostasis
Humans
hypercoagulability
Male
Middle Aged
Thrombelastography
thrombin
Thrombin - chemistry
thromboelastometry
Tissue Plasminogen Activator - metabolism
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Background The coagulopathy in cirrhosis is associated with thrombosis and bleeding. Objectives To gain better insights into the coagulopathy in patients with cirrhosis, we evaluated plasma thrombin generation and whole blood clot formation in a cross‐sectional study. Methods Blood was collected from 73 patients with all‐cause cirrhosis (Child‐Pugh‐A n = 52, B n = 15, C n = 6) and 20 healthy controls. Activity of the coagulation pathways was measured with assays for factor (F) VIIa and FIXa‐antithrombin and FXa‐antithrombin complexes, respectively. Thrombin generation by calibrated automated thrombography was determined in platelet‐poor plasma using a 1 or 5 pm tissue factor trigger with/without thrombomodulin. ROTEM measurements were performed in whole blood triggered with 35 pm tissue factor without/with 175 ng mL−1 tissue plasminogen activator (the latter refered to as ‘tPA‐ROTEM’). Results We observed an increased generation of FVIIa and a moderately elevated amount of FIXa (in complex with antithrombin) without apparent increase in FX activation in patients with cirrhosis. In accordance with this prothrombotic state, markers of thrombin generation potential were also increased upon increasing severity of cirrhosis. In the whole blood clotting assay we observed delayed clot formation and decreased clot strength associated with increased severity of cirrhosis. No significant differences were found for tPA‐ROTEM parameters of clot degradation. Conclusion These results indicate that cirrhosis patients have an overall procoagulant plasma milieu but a decreased whole blood clot formation capacity with an apparently unaltered resistance to clot lysis.
ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.12706