title: Procoagulant versus anticoagulant factors in cirrhotic patients.
abstract: OBJECTIVE
  Liver cirrhosis leads to decreased production of clotting factors that are generally all produced in the liver except factor VIII and von Willebrand factor. However, cirrhotic patients are not protected from thrombosis. The present study aimed to assess the procoagulant and anticoagulant factors in cirrhotic patients with and without bleeding and/or thrombotic events.
  
  
  METHODS
  A total of 102 adult subjects were enroled: 51 cirrhotic patients and 51 healthy controls. After full history taking with special attention given to thromboembolic and haemorrhagic events, platelet count, serum albumin, bilirubin, international normalised ratio (INR), PT, partial thromboplastin time (PTT), hepatitis B surface antigen (HBsAg), hepatitis B core (HBc) antibodies, hepatitis C virus (HCV) antibodies, factor VIII, protein C, Protac-induced coagulation inhibition percentage (PICI%) assay and abdominal ultrasound were performed for patients and controls. Upper gastrointestinal endoscopy was conducted for the patients.
  
  
  RESULTS
  Compared with control subjects, factor VIII and factor VIII/protein C were significantly higher, while protein C and PICI% were significantly lower among patients.
  
  
  CONCLUSIONS
  Patients with liver cirrhosis may have a tendency for bleeding or thrombosis according to the balance of coagulant and anticoagulant status. PICI%, the assay that evaluated the functionality of the protein C anticoagulant system, was significantly lower in patients compared to control subjects. Accordingly, low PICI% and high factor VIII/protein C ratio can be taken as an index of hypercoagulability in cirrhotic patients.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El Bokl
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Amal
authors.initials: A
authors.lastname: Shawky
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: George S
authors.initials: GS
authors.lastname: Riad
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt. Electronic address: dr.hisham_samy@yahoo.com.
authors.forename: Hisham S
authors.initials: HS
authors.lastname: Abdel Fattah
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Shalaby
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nady
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Dina
authors.initials: D
authors.lastname: Khattab
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000502:physiology*; D001779:Blood Coagulation Factors; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000378:metabolism*; D013927:Thrombosis / Q000097:blood / Q000209:etiology
chemical_list: D001779:Blood Coagulation Factors; D011486:Protein C; C427184:recombinant factor VIII SQ; D005169:Factor VIII
keywords: Anticoagulants; Cirrhosis; Procoagulants