Character of changes of system of a hemostasis at sick of a cirrhosis
Keywords:cirrhosis, hemostasis system, a koagulopatiya, thrombosis, a protein C, F VIII factor, dissemenirovanny intra vascular folding sindrom
Since there were doubts as to the causes of hemorrhagic complications in liver cirrhosis it is actual a topical study both pro- and anticoagulant hemostasis.
Aim. To evaluate the hemostatic system in patients with liver cirrhosis.
Material and methods. 190 patients with cirrhosis were under examination: 123 have gastrointestinal bleeding, 67 - refractory ascites. 84 patients died during examination. The duration of examination was from 2-3 weeks to 2.5-3 years.
Estimation of procoagulant unit include determining the number of platelets, prothrombin index, activated partial thromboplastin time, blood-coagulation factor F VIII, fibrinogen levels, "B" and D-dimer fibrinogen. Anticoagulant system was evaluated by activity of coagulation inhibitor of protein C.
Results. In 71.5 % of discharged patients with bleeding and 60.0% of deaths, the activity of blood-coagulation factor F VIII exceeded normal levels. Increased activity of F VIII in patients with ascites was at 66.7% and 92.0%, respectively. In the dynamics of the percentage of patients with elevated F VIII in all groups increased, reaching 85.8 %–94.0 % (p<0.01).
The activity of protein C anticoagulant factor for 71.4% -88.0% of patients, which hospitalized with complications of LC, was reduced, accounting for less than 70%. Low activity of protein C remained in dynamics such as those discharged and deceased patients, 68.0% and 75.0%, respectively, at DH and 90.0% -94.0% - at ascites, (p <0.01).
Confirmation of the presence of thrombophilia in cirrhotic patients is to determine the level of D-dimer. At 75.0% -97.0% of patients hospitalized with complications of the LC, the content of D-dimer in serum at admission was 5-8 times higher among patients subsequently discharged and 8-12 times among the dead, not decreasing over time ( p <0,01).
Conclusions. 1. Hemostasis of compensated cirrhotic patients is characterized by an imbalance toward hypercoagulation, as evidenced by the decrease in the activity of protein C with normal or increased activity of blood-coagulation factor FVIII.
2. Decompensated patients have varying degrees of hypocoagulation severity characterized by laboratory thrombocytopenia, decrease of prothrombin index, fibrinogen, increase of APTT, production of fibrin degradation products (D-dimer), which clinically defines hemorrhagic syndrome in liver cirrhosis.
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Copyright (c) 2015 Алий Саитович Тугушев, Виталий Викторович Вакуленко, Ольга Степановна Черковская, Дмитрий Иванович Михантьев, Вячеслав Васильевич Нешта, Павел Иванович Потапенко
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