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Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo-coagulable and Hyper-coagulable Features
Alberto Zanetto1,2,3, Henry M Rinder4,5, Elena Campello6
1Digestive Disease Section, Internal Medicine, Yale School of Medicine, New Haven, CT.
Hepatology (Baltimore, Md.)
|July 3, 2020
Summary
Acute kidney injury (AKI) in cirrhosis patients impairs platelet function and alters coagulation, increasing bleeding risk. AKI also presents mixed hypercoagulable and hyperfibrinolytic states, potentially raising thrombosis risk.
Area of Science:
- Nephrology
- Hepatology
- Hematology
Background:
- Acute kidney injury (AKI) is a key predictor of bleeding after paracentesis in cirrhosis patients.
- Understanding bleeding tendencies in AKI is crucial for managing cirrhosis patients.
Purpose of the Study:
- To investigate hemostasis alterations in decompensated cirrhosis patients with and without AKI.
- To compare platelet function, coagulation, and fibrinolysis in these patient groups.
Main Methods:
- Prospective study of 80 decompensated cirrhosis patients (40 with AKI, 40 without).
- Assessed primary (platelets, vWF), secondary (coagulation factors, thrombin), and tertiary (fibrinolysis) hemostasis.
- Compared hemostatic markers between AKI and non-AKI groups.
Main Results:
- Patients with AKI showed impaired platelet aggregation and secretion, indicating reduced platelet function.
- Coagulation analysis revealed hypercoagulability (higher FVIII, lower PC, PS, AT, increased thrombin generation) alongside hypocoagulability (lower FXIII).
- AKI was associated with a hyperfibrinolytic state (higher PAPC).
Conclusions:
- AKI in decompensated cirrhosis is linked to complex hemostatic abnormalities, including both hypocoagulable and hypercoagulable features.
- These alterations may increase the risk of both bleeding and thrombosis in affected patients.
- Resolution of AKI improved platelet function and coagulation, but fibrinolysis remained hyperactivated.
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