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2013, Number 2

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Rev Med MD 2013; 4.5 (2)

Coagulation factor abnormalities and variceal bleeding in decompensated cirrhotic patients

Contreras-Omaña R , Martínez-Silvestre E , Rojas-Corona L , Sinco-Ángeles A

Language: Spanish
References: 46
Page: 54-59
PDF size: 618.31 Kb.


ABSTRACT

Background For several years it was thought that bleeding events in decompensated cirrhotic patients, was associated with coagulation disorders. Nowadays, we know that the main cause of bleeding in these patients is portal hypertension.
Aims To demonstrate the relationship between variceal bleeding risk and coagulation anomalies in decompensated cirrhotic patients.
Methods We conducted a prospective, cross-sectional, analytical case-control design, in which 64 patients were enrolled. We worked with two groups and different coagulation parameters were measured such as: prothrombin time, platelets, partial thromboplastin time, bleeding time and euoglobulin lysis. The first group was made up of patients classified as Child Pugh B or C without evidence of variceal bleeding and the second group was made up of patients classified as Child Pugh B and C who had endoscopically documented variceal bleeding. Statistical analysis was performed using odds ratios.
Results In the analysis, we identified a state of hyperfibrinolysis quantified by determining euglobulins lysis: 6% control group, the case group 19%. Values of TPT were found prolonged in 53% of control group patients and in 40% of patients in the case group, with no significant statistical difference, On the measurement of bleeding time , 69% of patients who presented variceal bleeding showed a prolonged time, compared with 56% of controls without significant statistical difference. As for TP, alterations were found in 97% of patients with variceal bleeding, and 94% of controls, with no significant differences between groups. Regarding the various clotting variables studied, none was significantly associated with the presence of variceal bleeding when compared with controls. Finally, we found that the presence of esophageal varices is associated to a state of hyperfibrinolysis, regardless of the presence or absence of variceal bleeding.
Conclusions Our study showed that there is no relationship between variceal bleeding risk and coagulation alterations in decompensated cirrhotic patients.


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