title: Coagulation proteins influencing global coagulation assays in cirrhosis: hypercoagulability in cirrhosis assessed by thrombomodulin-induced thrombin generation assay.
abstract: BACKGROUND
  Liver disease is accompanied by profound hemostatic disturbances. We investigated the influences of pro- and anticoagulation factors on global coagulation tests including prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin generation assay (TGA) in cirrhosis. We also investigated whether cirrhotic patients exhibit hypo- or hypercoagulability using the TGA.
  
  
  METHODS
  The TGA was performed on a calibrated automated thrombogram, given lag time, endogenous thrombin potential (ETP), and peak thrombin in 156 cirrhotic patients and 73 controls.
  
  
  RESULTS
  PT was determined according to the factor (F) II, FV, FVII, FIX, and protein C levels. We observed that aPTT was dependent on FII, FIX, and FX levels. The ETP was dependent on FII, antithrombin, and protein C with 5 pM tissue factor (TF) stimulation, and FIX and protein C at 1 pM TF. The ETP ratio with 1 pM TF increased significantly in cirrhosis, indicating hypercoagulability, whereas that with 5 pM TF did not increase in cirrhosis.
  
  
  CONCLUSIONS
  PT and the TGA are sensitive to protein C levels. Even with prolonged PT, the TGA can detect hypercoagulability in cirrhosis. Further studies should evaluate global coagulation status in cirrhosis patients using the newly devised TGA system.
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Nam
authors.initials: N
authors.lastname: Youngwon
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Hae Sook
authors.initials: HS
authors.lastname: Lim
authors.forename: Kyou-Sup
authors.initials: KS
authors.lastname: Han
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000378:metabolism; D011517:Prothrombin Time; D013917:Thrombin / Q000032:analysis / Q000096:biosynthesis*; D018180:Thrombomodulin / Q000378:metabolism
chemical_list: D011486:Protein C; D018180:Thrombomodulin; D013917:Thrombin
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