Association of Heparin-Like Effect, Factor VII/XIII Deficiency and Fibrinolysis with Rebleeding Risk in Cirrhosis with Acute Variceal Bleeding.

Autor: Premkumar M; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. drmadhumitap@gmail.com., Mehtani R; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Kulkarni AV; Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India., Duseja AK; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., De A; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Taneja S; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Singh V; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Verma N; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Ahluwalia J; Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Kajal K; Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Divyaveer S; Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Roy A; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Gandotra A; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Kalson N; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Kekan K; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Kaur H; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India., Kaur H; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2023 Feb; Vol. 68 (2), pp. 497-513. Date of Electronic Publication: 2022 Aug 19.
DOI: 10.1007/s10620-022-07656-9
Abstrakt: Background: Hyperfibrinolysis and coagulation dysfunction may occur in cirrhotic patients with acute variceal bleed (AVB) despite successful endotherapy.
Aims: To prospectively study the association of endogenous heparinoids and coagulation dysfunction with variceal rebleeding and outcome in cirrhosis.
Methods: Consecutive patients were assessed with conventional coagulation tests, SONOCLOT™ [(global(gb) and heparinase(h) treated] and factors VII, VIII, XIII, X, tissue plasminogen activator, and plasminogen activator inhibitor ELISA assays in a university hospital. Heparin-like-effect (HLE) was defined as ≥ 20% difference in paired gb/h-SONOCLOT™ traces for activated clotting time (ACT).
Results: Of 143 patients screened, 90 (46.4 ± 11.7 years, males 82.2%, ethanol-related 58.8%) were recruited, who bled from esophageal varices (81,90.0%), gastric varices (6,6.6%), or esophageal varices with portal hypertensive gastropathy (3,3.3%). Twenty (21.7%) had early rebleeding, mainly post-variceal ligation ulcer related (70%). Patients who rebled had low Factor XIII [1.6 (1.2-2.1) vs 2.4 ng/ml (2.0-2.8) P = 0.035] and Factor VII (94.1 ± 46.9 vs. 124.0 ± 50.4, P = 0.023). On receiver operating curve analysis, the gbACT > 252 s (sensitivity 86.8%, specificity 76.9%, P < 0.001), hACT > 215 s (sensitivity 71.1%, specificity 70.3%, P < 0.001), and HLE > 50% (sensitivity 69.5%, specificity 70.3%, P = 0.006) predicted rebleeding. Baseline Factor VIII (HR 1.26; 95% CI 1.17-1.34, P < 0.001), low factor VII (HR 0.89; 95% CI 0.76-0.98, P = 0.035), and lysis (HR 1.25, 95% CI 1.17-1.33, P < 0.001) predicted mortality. Endogenous heparinoids at baseline predicted sepsis (HR 1.8; 95% CI 1.4-6.5; P = 0.022), rebleeding events (HR 1.2; 95% CI 1.1-6.3; P = 0.030), and mortality (HR 1.1; 95% CI 1.0-4.6; P = 0.030).
Conclusions: Hyperfibrinolysis, Factor VII/XIII deficiency, and HLE are associated with rebleeding after AVB. Trial Registration NCT04111120 available from https://clinicaltrials.gov/ct2/show/NCT04111120 .
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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