Coagulation profile and platelet function in patients with extrahepatic portal vein obstruction and non-cirrhotic portal fibrosis.
OBJECTIVE
Coagulation disorders commonly develop in patients with cirrhosis of the liver. They have also been reported in patients with non-cirrhotic portal fibrosis (NCPF) and extra-hepatic portal venous obstruction (EHPVO); the two conditions with portal hypertension and near-normal liver functions. The spectrum and prevalence of coagulation abnormalities and their association with the pathogenesis of these diseases and with hypersplenism was prospectively studied.


METHODS
Eighteen EHPVO patients that included an equal number of NCPF patients and 20 healthy controls were prospectively studied. The coagulation parameters assessed included: international normalized ratio, partial thromboplastin time, and fibrinogen and fibrinogen degradation products. Platelet aggregation and malondialdehyde levels were measured.


RESULTS
Both EHPVO (83%) and NCPF (78%) patients had a significantly prolonged international normalized ratio and a decrease in fibrinogen and platelet aggregation. The EHPVO patients had a significant prolongation in partial thromboplastin time (67% patients), with increased levels of fibrinogen degradation product levels occurring in all patients; these were normal in NCPF patients. Platelet malondialdehyde levels were normal in both groups. Hypersplenism was present in four EHPVO and seven NCPF patients. It did not significantly influence the coagulation profile in either NCPF or EHPVO patients.


CONCLUSIONS
Coagulation anomalies are common and significant in both NCPF and EHPVO patients, suggestive of a mild disseminated intravascular coagulation disorder. These imbalances could be caused by chronic subclinical endotoxemia and cytokine activation after the initial portal thromboembolic event. The persistence of these abnormalities in adolescent patients indicates an ongoing coagulation derangement.
Bajaj
J S
JS
Departments of; Gastroenterology and; Biochemistry, Govind Ballabh Pant Hospital, New Delhi, India.
Bhattacharjee
J
J
Sarin
S K
SK
D000293:Adolescent; D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications*; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D019446:Endotoxemia / Q000150:complications; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000150:complications; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D010974:Platelet Aggregation; D011169:Portal Vein; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000150:complications*