Impaired Platelet Aggregation and Rebalanced Hemostasis in Patients with Chronic Hepatitis C Virus Infection

Area of Science:

• Hematology
• Hepatology
• Cardiovascular Medicine

Background:

• Chronic hepatitis C (CHC) infection is linked to increased risks of cardiovascular disease (CVD) and bleeding.
• A re-balanced hemostasis has been proposed as a contributing factor in CHC patients.
• Understanding coagulation and platelet function is crucial for managing CHC-related complications.

Purpose of the Study:

• To investigate functional whole blood coagulation and platelet function in patients with CHC infection.
• To compare hemostatic function between CHC patients with advanced fibrosis and those with no or mild fibrosis, as well as healthy controls.
• To assess hemostatic changes after CHC treatment leading to sustained virological response (SVR).

Main Methods:

• Prospective study including 82 CHC patients (39 advanced fibrosis, 43 no/mild fibrosis) and 39 healthy controls.
• Assessment of hemostasis using standard coagulation tests and functional whole blood assays: thromboelastography (TEG) and platelet aggregation (Multiplate).
• Analysis of blood samples from 33 patients before and after CHC treatment achieving SVR.

Main Results:

• Patients with CHC and advanced fibrosis exhibited impaired platelet aggregation and lower antithrombin, platelet count, and coagulation factors II-VII-X compared to controls.
• Thromboelastography (TEG) results did not significantly differ between the groups.
• Following SVR achievement, platelet counts and specific platelet aggregation tests (ADPtest, ASPItest, RISTOhightest) increased, but remained below healthy control levels.

Conclusions:

• CHC-infected patients demonstrate evidence of rebalanced hemostasis, characterized by impaired platelet function.
• Hemostatic normalization is only partial in patients achieving SVR.
• The clinical implications of this rebalanced hemostasis on CVD and bleeding risks in CHC patients warrant further research.