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Coagulation inhibitors in alcoholic liver cirrhosis
J M Raya-Sánchez1, E González-Reimers, J M Rodríguez-Martín
1Dpto. de Medicina Interna, Hospital Universitario de Canarias, La Laguna, Tenerife, Canary Islands, Spain.
Insights
Alcoholic cirrhosis impacts coagulation, lowering inhibitors like antithrombin III and protein C. However, thrombomodulin and tissue plasminogen activator (t-PA) levels increase in cirrhotics, with normal plasminogen activator inhibitor (PAI-1) activity.
Area of Science:
- Hepatology
- Hematology
- Vascular Biology
Background:
- Alcoholic liver disease, specifically cirrhosis, is associated with complex hemostatic alterations.
- Coagulation inhibitors and fibrinolytic proteins play crucial roles in maintaining hemostasis.
- Understanding these changes is vital for managing cirrhotic patients.
Purpose of the Study:
- To investigate the relationship between liver function impairment in alcoholic cirrhosis and key coagulation inhibitors.
- To analyze plasma levels of endothelium-derived proteins, including tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1).
- To correlate these hemostatic parameters with the severity of liver dysfunction.
Main Methods:
- Comparative analysis of coagulation inhibitors (antithrombin III, protein C, protein S, thrombomodulin) and fibrinolytic factors (t-PA, PAI-1).
- Study included 27 patients with alcoholic cirrhosis and 25 healthy controls.
- Assessment of liver function using Child's classification.
Main Results:
- Cirrhotic patients exhibited reduced levels of antithrombin III, protein C, and protein S compared to controls.
- Thrombomodulin and t-PA levels were significantly elevated in cirrhotic patients.
- No significant correlation was found between thrombomodulin, t-PA, and the degree of hepatic dysfunction (Child's C). PAI-1 activity remained normal.
Conclusions:
- Alcoholic cirrhosis is characterized by a decrease in key coagulation inhibitors and an increase in thrombomodulin and t-PA.
- The severity of liver disease (Child's C) correlates with lower levels of protein C and antithrombin III.
- PAI-1 activity appears unaffected in this cohort of alcoholic cirrhotic patients.
Abstract:
In the present study we have analyzed the relationship between coagulation inhibitors (antithrombin III, protein C and S, thrombomodulin), liver function impairment, and plasma activity of the endothelium-derived proteins plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) in 27 alcoholic cirrhotic patients and 25 controls. Cirrhotics showed decreased values of all the mentioned parameters except for thrombomodulin, PAI-1, and t-PA. Thrombomodulin and t-PA levels were higher in cirrhotics. No relationship was observed between thrombomodulin and t-PA or PAI-1. Protein C and antithrombin III levels were significantly lower in Child's C patients, whereas no correlation was found between t-PA and thrombomodulin and hepatic function derangement. PAI-1 activity was normal in our patients.