DOI: https://doi.org/10.15587/2313-8416.2015.43105

Character of changes of system of a hemostasis at sick of a cirrhosis

Алий Саитович Тугушев, Виталий Викторович Вакуленко, Ольга Степановна Черковская, Дмитрий Иванович Михантьев, Вячеслав Васильевич Нешта, Павел Иванович Потапенко

Abstract


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.


Keywords


cirrhosis; hemostasis system; a koagulopatiya; thrombosis; a protein C; F VIII factor; dissemenirovanny intra vascular folding sindrom

References


Arshad, F., Lisman, T., Porte, R. J. (2013). Hypercoagulability as a contributor to thrombotic complications in the liver transplant recipient. Liver International, 33 (6), 820–827. doi: 10.1111/liv.12140

Francoz, C., Valla, D., Durand, F. (2012). Portal vein thrombosis, cirrhosis, and liver transplantation. Journal of Hepatology, 57 (1), 203–212. doi: 10.1016/j.jhep.2011.12.034

Lisman, T., Porte, R. J. (2012). Platelet function in patients with cirrhosis. Journal of Hepatology, 56 (4), 993–994. doi: 10.1016/j.jhep.2011.08.013

Mallett, S. V., Chowdary, P., Burroughs, A. K. (2013). Clinical utility of viscoelastic tests of coagulation in patients with liver disease. Liver International, 33 (7), 961–974. doi: 10.1111/liv.12158

Northup, P. G., Caldwell, S. H. (2013). Coagulation in Liver Disease: A Guide for the Clinician. Clinical Gastroenterology and Hepatology, 11 (9), 1064–1074. doi: 10.1016/j.cgh.2013.02.026

Rodriguez-Castro, K. I., Simioni, P., Burra, P., Senzolo, M. (2012). Anticoagulation for the treatment of thrombotic complications in patients with cirrhosis. Liver International, 32 (10), 1465–1476. doi: 10.1111/j.1478-3231.2012.02839.x

Tapper, E. B., Robson, S. C., Malik, R. (2013). Coagulopathy in cirrhosis – The role of the platelet in hemostasis. Journal of Hepatology, 59 (4), 889–890. doi: 10.1016/j.jhep.2013.03.040

Tripodi, A., Mannucci, P. M. (2011). The Coagulopathy of Chronic Liver Disease. New England Journal of Medicine, 365 (2), 147–156. doi: 10.1056/nejmra1011170

Agarwal, B., Wright, G., Gatt, A., Riddell, A., Vemala, V., Mallett, S. et. al. (2012). Evaluation of coagulation abnormalities in acute liver failure. Journal of Hepatology, 57 (4), 780–786. doi: 10.1016/j.jhep.2012.06.020

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Lisman, T., Caldwell, S. H., Burroughs, A. K., Northup, P. G., Senzolo, M., Stravitz, R. T. et. al. (2010). Hemostasis and thrombosis in patients with liver disease: The ups and downs. Journal of Hepatology, 53 (2), 362–371. doi: 10.1016/j.jhep.2010.01.042


GOST Style Citations


Arshad, F. Hypercoagulability as a contributor to thrombotic complications in the liver transplant recipient [Text] / F. Arshad, T. Lisman, R. J. Porte // Liver International. – 2013. – Vol. 33, Issue 6. – Р. 820–827. doi: 10.1111/liv.12140 

Francoz, C. Portal vein thrombosis, cirrhosis, and liver transplantation [Text] / C. Francoz, D. Valla, F. Durand // Journal of Hepatology. – 2012. – Vol. 57, Issue 1. – Р. 203–212. doi: 10.1016/j.jhep.2011.12.034 

Lisman, T. Platelet function in patients with cirrhosis [Text] / T. Lisman, R. J. Porte // Journal of Hepatology. – 2012. – Vol. 56, Issue 4. – Р. 993–994. doi: 10.1016/j.jhep.2011.08.013 

Mallett, S. V. Clinical utility of viscoelastic tests of coagulation in patients with liver disease [Text] / S. V. Mallett, P. Chowdary, A. K. Burroughs // Liver International. – 2013. – Vol. 33, Issue 7. – Р. 961–974. doi: 10.1111/liv.12158 

Northup, P. G. Coagulation in Liver Disease: A Guide for the Clinician [Text] / P. G. Northup, S. H. Caldwell // Clinical Gastroenterology and Hepatology. – 2013. – Vol. 11, Issue 9. – P. 1064–1074. doi: 10.1016/j.cgh.2013.02.026 

Rodriguez-Castro, K. I. Anticoagulation for the treatment of thrombotic complications in patients with cirrhosis [Text] / K. I. Rodriguez-Castro, P. Simioni, P. Burra, M. Senzolo // Liver International. – 2012. – Vol. 32, Issue 10. – P. 1465–1476. doi: 10.1111/j.1478-3231.2012.02839.x 

Tapper, E. B. Coagulopathy in cirrhosis – The role of the platelet in hemostasis [Text] / E. B. Tapper, S. C. Robson, R. Malik // Journal of Hepatology. – 2013. – Vol. 59, Issue 4. – Р. 889–890. doi: 10.1016/j.jhep.2013.03.040 

Tripodi, A. The Coagulopathy of Chronic Liver Disease [Text] / A. Tripodi, P. M. Mannucci // New England Journal of Medicine. – 2011. – Vol. 365, Issue 2. – Р. 147–156. doi: 10.1056/nejmra1011170 

Agarwal, B. Evaluation of coagulation abnormalities in acute liver failure [Text] / B. Affiliations, G. Affiliations, A. Gatt, A. Riddell, V. Vemala, S. Mallett et al. // Journal of Hepatology. – 2012. – Vol. 57, Issue 4. – P. 780–786. doi: 10.1016/j.jhep.2012.06.020 

Guerrero, J. A. Protective role of antithrombin in mouse models of liver injury [Text] / J. A. Guerrero, R. Affiliations, C. Martínez, I. Arcas, I. Martínez-Martínez, M. E. de la Morena-Barrio et. al. // Journal of Hepatology. – 2012. – Vol. 57, Issue 5. – Р. 980–986. doi: 10.1016/j.jhep.2012.06.023 

Lisman, T. Hemostasis and thrombosis in patients with liver disease: The ups and downs [Text] / T. Lisman, S. H. Caldwell, A. K. Burroughs, P. G. Northup, M. Senzolo, R. T. Stravitz et al. // Journal of Hepatology. – 2010. – Vol. 53, Issue 2. – P. 362–371. doi: 10.1016/j.jhep.2010.01.042 







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