Expression of Procoagulant Microparticles Assessed by Thrombin Generation Test in Cirrhosis

Abstract

Background Cirrhosis is associated with an increased frequency of thromboembolic events, particularly in the portal sector. Several hypotheses have been put forward to explain this hypercoagulability state. However, studies assessing the expression of procoagulant microparticles (MP) in cirrhosis are rare. Aims To evaluate the expression of procoagulant MP in cirrhosis using thrombin generation (TG) test and to assess the activity of MP according to the clinical and biological status of patients. Methods 39 cirrhotic patients and 39 control subjects were enrolled in a cross sectional comparative study. The biological explorations were performed at inclusion (The conventional tests of hemostasis, factor VIII (FVIII) and protein C (PC) assay and TG test carried out under sensitive conditions to MP activity and standard conditions). Results The mean age of patients was 65 years. Etiologies were dominated by viral infection (64%). The majority of patients were classified as Child-Pugh stage A (49%) and had decompensated cirrhosis (54%). Portal thrombosis was observed in 9 patients and hepatocellular carcinoma (HCC) was documented in 14 patients. Cirrhotic patients had higher FVIII/PC ratio and lower TG under different experimental conditions than controls. However, by expressing the results of MP dependent TG to the results of TG under optimal condition, patients generated as much thrombin as controls. MP dependent TG increased with the severity, decompensated status and complications of the disease. Conclusion The MP procoagulant activity in cirrhotic patients is comparable to that in controls and increases with disease severity, decompensation, and complications.