title: [Low sensibility to the action of thrombomodulin in cirrhotic patients. Interest of thrombinography].
abstract: Cirrhosis is associated with complex hemostatic modifications. Most coagulation factors, either procoagulants or anticoagulants, are reduced. Conventional coagulation tests (prothrombin time, activated partial thromboplastin time) don't allow to precisely identify the thrombotic risk as they are not sensible to coagulation inhibitors deficiencies. The aim of this study was to evaluate the coagulation in a population of cirrhotic patients using thrombinography. We analyzed the plasma samples from 30 cirrhotic patients (10 Child A, 10 Child B, Child C 10) compared to 10 healthy controls using thrombinography with and without thrombomodulin to sensiblise this test at the activated protein C pathway. The results of endogenous thrombin potential, the main parameter, expressed as a ratio (thrombinography with/without thrombomodulin) were significantly higher in cirrhotic patients (0.69 ± 0.16) than in controls (0.49 ± 0.10) which reflects a low sensibility to the action of thrombomodulin. This resistance increases with the severity of the disease assessed by the Child-Pugh score, demonstrating a potential hypercoagulable state. The results of the thrombinography challenge the dogma that cirrhotic patients are naturally "anticoagulated." These results highlight the potential interest of the thrombinography in the detection and monitoring of hypercoagulability in cirrhotic patient. Increasing hypercoagulability with the severity of the disease seems to be correlated with clinical observations since the occurrence of thrombosis is more common when cirrhosis is at an advanced stage.
authors.affiliation: Service d'hématologie biologique, Hôpital Estaing, Centre hospitalier universitaire de Clermont-Ferrand, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sinegre
authors.affiliation: Service d'hépatologie, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, France.
authors.forename: Armand
authors.initials: A
authors.lastname: Abergel
authors.affiliation: Service d'hématologie biologique, Hôpital Estaing, Centre hospitalier universitaire de Clermont-Ferrand, France.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Sapin
authors.affiliation: Service d'hépatologie, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Lamblin
authors.affiliation: Service d'hématologie biologique, Hôpital Estaing, Centre hospitalier universitaire de Clermont-Ferrand, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Marques-Verdier
authors.affiliation: Service d'hépatologie, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Duron
authors.affiliation: Service d'hématologie biologique, Hôpital Estaing, Centre hospitalier universitaire de Clermont-Ferrand, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Lebreton
mesh_terms: D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018180:Thrombomodulin / Q000097:blood / Q000502:physiology*
chemical_list: D018180:Thrombomodulin
keywords: activated protein C resistance; cirrhosis; hypercoagulability; protein C; thrombinography; thrombomodulin