Bleeding in cirrhotic patients: a precipitating factor due to intravascular coagulation or to hepatic failure?
In 24 cirrhotic patients at different stages of hepatic failure, factor VIII:C (F VIII:C), factor VIIIR:AG (F VIIIR:AG), factor VIII AG/C ratio (F VIII AG/C), and serum fibrin-fibrinogen degradation products (FDP) were investigated. In 11 of the 24 patients, several instances of gastrointestinal bleeding due to esophageal varices rupture were documented and 5 patients died of unarrestable bleeding. In our study, we evaluated whether the cause of bleeding was the development of intravascular coagulation or the severity of hepatic failure. A statistically significant difference between F VIII:C, F VIIIR:AG/C ratio, and serum FDP was found in bleeding in comparison with non-bleeding patients. An inverse correlation between the F VIII:C plasma level and serum FDP as well as a direct correlation between F VIII AG/C ratio and serum FDP in the group of bleeding patients were also found. These data seem to suggest a hypercoagulable state which was more significant in the 5 patients who died owing to bleeding. Furthermore, only 1 of these patients had severe hepatic failure. From this study it appears that, in cirrhotic patients, bleeding is related more to the appearance of disseminated intravascular coagulation, as a consequence of both hemodynamic and endothelial changes, than to the degree of hepatic failure itself.
D000328:Adult; D000941:Antigens / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005169:Factor VIII / Q000032:analysis / Q000276:immunology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D014841:von Willebrand Factor
D000941:Antigens; D005338:Fibrin Fibrinogen Degradation Products; D014841:von Willebrand Factor; D005169:Factor VIII