title: Endogenous heparinoids detected by anti-Xa activity are present in blood during acute variceal bleeding in cirrhosis. A prospective study.
abstract: OBJECTIVE
  Endogenous heparinoids have been detected by thromboelastography and quantified by clotting based anti-Xa activity assays in patients with cirrhosis, but their presence in variceal bleeding has not been established yet.
  
  
  METHODS
  Clotting based anti-Xa activity was measured in A) 30 cirrhotics with variceal bleeding, B) 15 non-cirrhotics with peptic ulcer bleeding, C) 10 cirrhotics without infection or bleeding, and D) 10 cirrhotics with hepatocellular carcinoma (HCC).
  
  
  RESULTS
  Anti-Xa activity was not detected in ulcer bleeders or in cirrhotics without infection or bleeding but was present in seven (23%) variceal bleeders (median levels: 0.03 u/mL (0.01-0.07)) and was quantifiable for 3 days in six of seven patients. Four of seven variceal bleeders with anti-Xa activity present had HCC (p=0.023). Age, creatinine, platelet count and total infections the second day from admission were significantly correlated with the presence of measureable anti-Xa levels (p=0.014, 0.032, 0.004 and 0.019, respectively). In the HCC group, anti-Xa activity was present in three patients (30%) [median levels: 0.05 u/mL (0.01-0.06)].
  
  
  CONCLUSIONS
  In this study, variceal bleeders and 30% of the patients with HCC had endogenous heparinoids that were detected by a clotting based anti-Xa activity assay, whereas there was no anti Xa activity present in patients with cirrhosis without infection, or bleeding or HCC, nor in those with ulcer bleeding. Thus, the anti Xa activity is likely to be a response to bacterial infection and/or presence of HCC in cirrhosis.
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece. chtriantos@hotmail.com.
authors.forename: Christos
authors.initials: C
authors.lastname: Triantos
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Louvros
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kalafateli
authors.affiliation: Katharine Dormandy Haemophilia Centre & Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Riddell
authors.affiliation: Institute of Liver and Digestive Health, UCL London, London, UK.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Thalheimer
authors.affiliation: Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Michailidou
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Thomopoulos
authors.affiliation: Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Lampropoulou-Karatza
authors.affiliation: Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Gogos
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Nikolopoulou
authors.affiliation: Institute of Liver and Digestive Health, UCL London, London, UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000208:Acute Disease; D000368:Aged; D001424:Bacterial Infections / Q000097:blood / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000097:blood* / Q000209:etiology; D065427:Factor Xa Inhibitors / Q000097:blood*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood* / Q000209:etiology; D006496:Heparinoids / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000097:blood; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D065427:Factor Xa Inhibitors; D006496:Heparinoids