title: Coagulation abnormalities in patients with chronic liver disease in Pakistan.
abstract: OBJECTIVE
  To determine the coagulation abnormalities and relationship between abnormal clotting tests and the risk of gastrointestinal bleeding (GI) among chronic liver disease (CLD) patients admitted at a tertiary care hospital in Pakistan.
  
  
  METHODS
  Adult CLD patients admitted at Liaquat University Hospital Jamshoro, during Nov 2004-Oct 2005, were included in the study. The patients blood were tested for coagulation abnormalities including prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count and plasma fibrinogen. Association was seen between the abnormal clotting tests and the gastrointestinal bleeding by calculating relative risk (RR) with 95% confidence interval.
  
  
  RESULTS
  PT was prolonged in 88% and aPTT was raised in 71% cases of CLD. Both PT and aPTT were prolonged in 67% CLD cases. Approximately 37% CLD cases had decreased platelet count and 15% cases had decreased serum fibrinogen level. Relative risk of GI bleeding with abnormal clotting tests in CLD cases were weakly positive for PT (RR = 1.02; 95% CI, 0.49-2.10), negative for aPTT (RR = 0.83; 95% CI, 0.47-1.45), strongly positive for decreased platelet counts (RR = 1.96; 95% CI, 1.08-3.56) and also for decreased fibrinogen level (RR = 1.47; 95% CI, 0.64-3.35).
  
  
  CONCLUSIONS
  Coagulation abnormalities were profound in CLD. Decrease platelet counts and fibrinogen levels were related with GI bleeding but PT and aPTT were not significantly related with GI bleeding in patients with chronic liver disease. Nevertheless, these parameters (PT and aPTT) were still used as prognostic markers.
authors.affiliation: Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh.
authors.forename: Sohail Ahmed
authors.initials: SA
authors.lastname: Siddiqui
authors.forename: Mubashir
authors.initials: M
authors.lastname: Ahmed
authors.forename: Muhammad Hanif
authors.initials: MH
authors.lastname: Ghani
authors.forename: Muhammad Anwar
authors.initials: MA
authors.lastname: Memon
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.forename: Muhammad Aslam
authors.initials: MA
authors.lastname: Ghori
mesh_terms: D000293:Adolescent; D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001780:Blood Coagulation Tests; D001791:Blood Platelet Disorders / Q000209:etiology; D002908:Chronic Disease; D016001:Confidence Intervals; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology*; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D012306:Risk; D012307:Risk Factors; D017678:Sex Distribution; D013921:Thrombocytopenia / Q000209:etiology; D055815:Young Adult
chemical_list: D005340:Fibrinogen