Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development

Zocco, Maria Assunta; Di Stasio, Enrico; De Cristofaro, Raimondo; Novi, Marialuisa; Ainora, Maria Elena; Ponziani, Francesca; Riccardi, Laura; Lancellotti, Stefano; Santoliquido, Angelo; Flore, Roberto; Pompili, Maurizio; Rapaccini, Gian Lodovico; Tondi, Paolo; Gasbarrini, Giovanni Battista; Landolfi, Raffaele; Gasbarrini, Antonio

doi:10.1016/j.jhep.2009.03.013

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Volume 51, Issue 4 , Pages 682-689, October 2009

Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development☆

Maria Assunta Zocco
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
- Corresponding author. Tel.: +39 347 0597805; fax: +39 06 35502775.
Enrico Di Stasio
- Department of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Rome, Italy
Raimondo De Cristofaro
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Marialuisa Novi
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Maria Elena Ainora
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Francesca Ponziani
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Laura Riccardi
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Stefano Lancellotti
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Angelo Santoliquido
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Roberto Flore
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Maurizio Pompili
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Gian Lodovico Rapaccini
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Paolo Tondi
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Giovanni Battista Gasbarrini
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Raffaele Landolfi
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
Antonio Gasbarrini
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy

Received 9 October 2008; received in revised form 19 February 2009; accepted 17 March 2009. published online 23 April 2009.

Associate Editor: J. Bosch

Background/Aims

Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a function of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients.

Methods

One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Variables able to predict PVT development within 1 year were identified by means of multiple logistic regression.

Results

The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development.

Conclusions

Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrhosis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis.

Keywords: Thrombotic risk factors, Liver cirrhosis, MELD score, Portal vein thrombosis, Portal flow velocity

Abbreviations: TRFs, thrombotic risk factors, PVT, portal vein thrombosis, AT, antithrombin, APA, antiphospholipid antibodies, MELD, Model for End-stage Liver Disease, LAC, lupus anticoagulant, INR, international normalized ratio, APTT, activated partial thromboplastin time, ELISA, enzyme-linked immunosorbent assay, PT, prothrombin time

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☆ The authors who have taken part in this study declared that they do not have anything to disclose regarding funding from industry or conflict of interest with respect to this manuscript.

PII: S0168-8278(09)00250-5

doi:10.1016/j.jhep.2009.03.013

Refers to article:

Portal vein thrombosis: A predictable milestone in cirrhosis? , 29 June 2009
Juan Carlos Garcia-Pagan, Dominique-Charles Valla
Journal of Hepatology October 2009 (Vol. 51, Issue 4, Pages 632-634)
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