Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development.
OBJECTIVE
Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a function of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients.


METHODS
One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Variables able to predict PVT development within 1 year were identified by means of multiple logistic regression.


RESULTS
The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development.


CONCLUSIONS
Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrhosis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis.
Zocco
Maria Assunta
MA
Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy. mariaazocco@hotmail.com
Di Stasio
Enrico
E
De Cristofaro
Raimondo
R
Novi
Marialuisa
M
Ainora
Maria Elena
ME
Ponziani
Francesca
F
Riccardi
Laura
L
Lancellotti
Stefano
S
Santoliquido
Angelo
A
Flore
Roberto
R
Pompili
Maurizio
M
Rapaccini
Gian Lodovico
GL
Tondi
Paolo
P
Gasbarrini
Giovanni Battista
GB
Landolfi
Raffaele
R
Gasbarrini
Antonio
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000378:metabolism; D001783:Blood Flow Velocity; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology; D011379:Prognosis; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000378:metabolism; D012307:Risk Factors; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology
D000991:Antithrombins; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; D017293:Protein S; C036309:fibrin fragment D