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Platelet Function Decreases with Increasing Severity of Liver Cirrhosis and Portal Hypertension-A Prospective Study

Ksenia Brusilovskaya1,2,3, Benedikt Silvester Hofer1,2,3, Benedikt Simbrunner1,2,3,4

  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

Thrombosis and Haemostasis
|July 30, 2023
PubMed

Insights

Platelet activation and responsiveness decrease in patients with advanced cirrhosis and portal hypertension. This reduced platelet function may be associated with lower antithrombin-III levels.

Area of Science:

  • Hepatology
  • Hematology
  • Thrombosis Research

Background:

  • Cirrhosis increases bleeding and thrombosis risk.
  • Platelet activation is a key factor in hemostasis and thrombosis.
  • Understanding platelet behavior in cirrhosis is crucial for managing patient outcomes.

Purpose of the Study:

  • To investigate platelet activation in cirrhotic patients across different Child-Pugh stages (CPS) and portal hypertension (PH) severity.
  • To assess the expression of platelet activation markers in response to various agonists.
  • To correlate platelet activation with clinical parameters like PH severity and antithrombin-III levels.

Main Methods:

  • Prospective study of 110 cirrhotic patients.
  • Assessment of Child-Pugh stage (CPS) and hepatic venous pressure gradient (HVPG).
  • Flow cytometry measurement of platelet P-selectin and activated glycoprotein (GP) IIb/IIIa expression before and after stimulation with agonists (PAR-1, PAR-4, epinephrine, LPS).

Main Results:

  • Platelet count decreased with increasing PH severity.
  • Reduced P-selectin and activated GPIIb/IIIa expression in response to PAR-1 and PAR-4 agonists in Child-Pugh B/C patients and those with HVPG ≥20 mmHg.
  • Decreased P-selectin expression with epinephrine/LPS in CPS-C patients; reduced activated GPIIb/IIIa with these agonists in CPS-B/C patients.
  • Lower antithrombin-III levels correlated with reduced platelet activation via PAR-1 and PAR-4.

Conclusions:

  • Platelet responsiveness diminishes with advancing liver cirrhosis and portal hypertension severity.
  • Reduced platelet activation in severe cirrhosis and PH may be linked to lower antithrombin-III levels.
  • These findings highlight altered platelet function in cirrhosis and its potential clinical implications.
Abstract

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