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Disordered hemostasis in extrahepatic portal hypertension
S C Robson1, D Kahn, J Kruskal
1Department of Medicine, University of Cape Town, South Africa.
Hepatology (Baltimore, Md.)
|October 1, 1993
Summary
Portal-systemic shunts contribute to coagulopathy in patients with liver disease, even without cirrhosis. This study highlights hemostasis abnormalities in extrahepatic portal hypertension, indicating shunts impact blood clotting.
Area of Science:
- Gastroenterology
- Hematology
- Hepatology
Background:
- Portal hypertension, a condition characterized by elevated pressure in the portal vein system, can arise from various causes, including liver cirrhosis and portal vein thrombosis.
- Coagulopathy, or impaired blood clotting, is a common complication in patients with liver disease, often attributed to impaired synthesis of clotting factors and thrombocytopenia.
Purpose of the Study:
- To investigate the role of naturally occurring portal-systemic shunts in the coagulopathy observed in patients with liver disease.
- To compare hemostatic parameters in patients with extrahepatic portal hypertension (EHPH) due to portal vein thrombosis (PVT) with those of patients with cirrhosis and healthy controls.
Main Methods:
- Laboratory hemostasis parameters were analyzed in 20 adult patients with EHPH (secondary to PVT) and normal liver function.
- Control groups included 20 healthy individuals and 20 patients with cirrhosis and portal hypertension.
- Key parameters assessed included prothrombin international normalized ratio (INR), partial thromboplastin time (PTT) ratios, serum fibrinogen-related antigen, fibrin monomer, and D-dimer levels.
Main Results:
- Both EHPH and cirrhotic patients exhibited thrombocytopenia, consistent with hypersplenism and portal hypertension.
- Significantly prolonged prothrombin INR and PTT ratios were observed in both patient groups compared to controls.
- Elevated levels of serum fibrinogen-related antigen, fibrin monomer, and D-dimer were found in EHPH and cirrhotic patients, indicating increased fibrin turnover and activation.
Conclusions:
- Naturally occurring portal-systemic shunts, even in the absence of cirrhosis, contribute significantly to coagulopathy in patients with portal hypertension.
- EHPH due to PVT leads to hemostatic abnormalities comparable to those seen in cirrhotic patients.
- These findings underscore the importance of evaluating coagulation status in patients with EHPH and highlight the impact of shunts on hemostasis.