| Sumario: | Background: Cirrhosis is associated with an increased frequency of thromboembolic events, particularly in the portal sector. Several hypotheses have been put forward to explain this hypercoagulability state. However, studies assessing the expression of procoagulant microparticles (MP) in cirrhosis are rare. Aims: To evaluate the expression of procoagulant MP in cirrhosis using thrombin generation (TG) test and to assess the activity of MP according to the clinical and biological status of patients. Methods: 39 cirrhotic patients and 39 control subjects were enrolled in a cross sectional comparative study. The biological explorations were performed at inclusion (The conventional tests of hemostasis, factor VIII (FVIII) and protein C (PC) assay and TG test carried out under sensitive conditions to MP activity and standard conditions). Results: The mean age of patients was 65 years. Etiologies were dominated by viral infection (64%). The majority of patients were classified as Child-Pugh stage A (49%) and had decompensated cirrhosis (54%). Portal thrombosis was observed in 9 patients and hepatocellular carcinoma (HCC) was documented in 14 patients. Cirrhotic patients had higher FVIII/PC ratio and lower TG under different experimental conditions than controls. However, by expressing the results of MP dependent TG to the results of TG under optimal condition, patients generated as much thrombin as controls. MP dependent TG increased with the severity, decompensated status and complications of the disease. Conclusion: The MP procoagulant activity in cirrhotic patients is comparable to that in controls and increases with disease severity, decompensation, and complications. Plain Language Summary: For a long time, cirrhosis with liver failure was traditionally believed to cause bleeding tendency due to coagulation factors deficiency. However, it is now recognized that cirrhosis also increased the risk of blood clots. While several explanations have been proposed, a few studies have investigated the role of procoagulant microparticles (MP), defined as small membrane-derived vesicles released from cells during activation or apoptosis, in cirrhosis, despite their known role in clot formation in other diseases. Therefore, this study aimed to assess the role of procoagulant MP in cirrhotic patients through thrombin generation (TG) assay, a global test of hypercoagulability. The levels of factor VIII (FVIII) and protein C (PC), representing procoagulant and anticoagulant factors respectively, were measured. the FVIII / PC ratio was calculated as marker of clotting tendency. A total of 39 cirrhotic patients and 39 healthy controls were enrolled. The mean age of patients was 65 years. Etiologies of cirrhosis were dominated by viral infection (64%). Mild cirrhosis was observed in 49% of patients and decompensated cirrhosis in 54%. Portal thrombosis was detected in 9 patients and hepatocellular carcinoma (HCC) was documented in 14 patients. The results showed that cirrhotic patients had higher FVIII/PC ratio and produced less thrombin (lower TG under different experimental conditions) than healthy individuals. However, when comparing MP related TG with TG under optimal conditions, patients generated as much thrombin as controls. MP dependent TG increased with severity, decompensation status and complications of the disease. In summary, MP procoagulant activity in cirrhotic patients is at least as high as in controls and increases further in severe, decompensated or complicated cirrhosis.
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