Hypercoagulability in patients with primary biliary cirrhosis and primary sclerosing cholangitis evaluated by thrombelastography

被引:154
作者
BenAri, Z
Panagou, M
Patch, D
Bates, S
Osman, E
Pasi, J
Burroughs, A
机构
[1] ROYAL FREE HOSP,HAEMOPHILIA CTR,LONDON NW 2QG,ENGLAND
[2] ROYAL FREE HOSP,HAEMOSTASIS UNIT,LONDON NW 2QG,ENGLAND
关键词
hypercoagulability; primary biliary cirrhosis; primary sclerosing cholangitis; thrombelastography;
D O I
10.1016/S0168-8278(97)80420-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/Aims: Patients with primary biliary cirrhosis and primary sclerosing cholangitis survive variceal bleeding better than patients with alcoholic cirrhosis and have less bleeding at liver transplantation. Recently, patients with primary biliary cirrhosis have been found to have a higher incidence of thrombosis in the portal venous tree, We hypothesized that primary biliary cirrhosis and primary sclerosing cholangitis patients may be hypercoagulable. Methods: We used thrombelastography, which is a simple technique for evaluating whole blood clotting and fibrinolysis, to establish if hypercoagulability was present, defined by thrombelastography values greater than 2SD over controls: r<19 mm (this reflects plasma clotting factors), maximum amplitude (ma) >60 mm, and alpha angle >43 degrees (these reflect platelets and fibrinogen levels), We evaluated 47 primary biliary cirrhosis and 21 primary sclerosing cholangitis patients, 40 with non-cholestatic cirrhosis and 40 healthy subjects as control groups with thrombelastography, full blood count, prothrombin time, partial thromboplastin time and, fibrinogen concentrations, In those with hypercoagulability we evaluated protein S, C, anti-thrombin III levels and activated protein C phenotype. Results: All three thrombelastography abnormalities present together defined hypercoagulability: these were found in 13 of 47 (28%) primary biliary cirrhosis and in nine of 21 (43%) primary sclerosing cholangitis patients independent of cirrhosis, and bilirubin concentration, but in only 2 of 40 (5%) patients with noncholestatic cirrhosis and in none of the healthy controls (p<0.03 and p<0.0002, respectively), There was no correlation between the fibrinogen concentration (which was normal in all patients) or platelet count and the thrombelastography parameters, Only six of the 22 hypercoagulable patients had lower than normal values of protein S, C or antithrombin III. Activated protein C phenotype was normal in all. Conclusions: This difference between biliary and parenchymal liver disease may have clinical implications, which need to be defined.
引用
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页码:554 / 559
页数:6
相关论文
共 16 条
  • [1] AROUSSEAU MH, 1981, HAEMOSTASIS, V10, P104
  • [2] BIAGINI MR, 1990, GUT, V31, pA1209
  • [3] RADIOIMMUNOASSAYS FOR PROTEIN C AND FACTOR-X - PLASMA ANTIGEN LEVELS IN ABNORMAL HEMOSTATIC STATES
    EPSTEIN, DJ
    BERGUM, PW
    BAJAJ, SP
    RAPAPORT, SI
    [J]. AMERICAN JOURNAL OF CLINICAL PATHOLOGY, 1984, 82 (05) : 573 - 581
  • [4] ASSESSMENT OF HYPERCOAGULABILITY IN PATIENTS WITH CANCER USING THE SONOCLOT-ANALYZER(TM) AND THROMBOELASTOGRAPHY
    FRANCIS, JL
    FRANCIS, DA
    GUNATHILAGAN, GJ
    [J]. THROMBOSIS RESEARCH, 1994, 74 (04) : 335 - 346
  • [5] PROSPECTIVE EVALUATION OF ESOPHAGEAL-VARICES IN PRIMARY BILIARY-CIRRHOSIS - DEVELOPMENT, NATURAL-HISTORY, AND INFLUENCE ON SURVIVAL
    GORES, GJ
    WIESNER, RH
    DICKSON, ER
    ZINSMEISTER, AR
    JORGENSEN, RA
    LANGWORTHY, A
    [J]. GASTROENTEROLOGY, 1989, 96 (06) : 1552 - 1552
  • [6] HARTERT H., 1962, BIORHEOLOGY, V1, P31
  • [7] KANG Y, 1989, Anesthesiology (Hagerstown), V71, pA8
  • [8] KANG YG, 1985, ANESTH ANALG, V64, P888
  • [9] LEE BY, 1981, HDB NONINVASIVE DIAG, pCH7
  • [10] THROMBELASTOGRAPHY
    MALLETT, SV
    COX, DJA
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 1992, 69 (03) : 307 - 313