title: Measurement of the procoagulant activity of factor VII in patients with liver cirrhosis and normal prothrombin activity: evaluation of the bleeding risk.
abstract: Patients with liver cirrhosis and diminished prothrombin activity (PA) have decreased levels of factor (F)VII coagulation activity (FVII:C) and an increased bleeding tendency. Whether this is also true of cirrhotic patients with normal PA is unknown. This study measured FVII:C levels in such patients and investigated the correlation between altered FVII:C levels and bleeding tendency. Fifteen of 41 patients (37%) had decreased FVII:C levels. Of these, the Child-Pugh score of liver function was A (n = 9), B (n = 5) and C (n = 1), compared to A (n = 25) and B (n = 1) in patients with normal FVII:C values (chi2 = 8.88, P = 0.012). Bleeding time was significantly prolonged in 9/15 patients (60%) with impaired FVII:C activity, compared to 3/26 (12%) patients with normal FVII:C values (relative risk: 5.2, 95% CI: 1.7-16.6; P = 0.003). In conclusion, liver cirrhosis patients may show impaired FVII:C levels despite normal PA. In those with decreased FVII:C activity, prolonged bleeding time is hypothesized to arise from an alteration in platelet activation due to FVII deficiency and diminished platelet count. Bleeding risk should be evaluated, regardless of platelet count, before these patients are subjected to invasive diagnostic or surgical procedures.
authors.affiliation: Department of Hepatology, Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Manzano
authors.forename: C
authors.initials: C
authors.lastname: Arocena
authors.forename: J F
authors.initials: JF
authors.lastname: Tomás
authors.forename: U
authors.initials: U
authors.lastname: Hedner
authors.forename: J A
authors.initials: JA
authors.lastname: Quiroga
authors.forename: V
authors.initials: V
authors.lastname: Carreño
mesh_terms: D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D005167:Factor VII / Q000378:metabolism*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011516:Prothrombin / Q000378:metabolism*; D012306:Risk
chemical_list: D005167:Factor VII; D011516:Prothrombin