ALBERT

Description: The decreased hepatic synthesis of coagulation factors is a marker of liver failure and a prognostic indicator of survival in cirrhosis. The aPTT and PT/INR are the conventional coagulation tests to measure the haemostatic capacity of the liver. The INR was developed uniquely for use in patients under oral anticoagulation and may not adequately reflect the coagulation changes in liver cirrhosis. However, prognostic models for liver disease include the INR (MELD). New coagulation assessment tests are obviously needed in liver cirrhosis. Recently a test has become available to routinely measure the endogenous thrombin generation potential (ETP). This more physiological test is currently investigated in several haemostatic disorders but not yet in liver failure. The aim of the study is to investigate correlations between ETP performed on the BCS® system (both Dade Behring, Marburg, Germany) and liver function tests, and compared with INR. We analysed 112 patients with liver cirrhosis (73 Child A, 21 Child B, 18 Child C) without known pre-existing coagulation abnormalities. In these patients ETP, APTT, PT/INR and S-cholinesterase were measured and an C14-Aminopyrine breathing test was performed. Both INR and ETP show good correlation with the Child score (P

Description: The maintenance of hemostasis through the production of most of the coagulation proteins is a basic liver function. In patients with cirrhosis of the liver the decrease in these proteins is one of the contributory factors to an increased bleeding tendency. Normally the hemostatic capacity of the liver is measured through routine clotting tests as the activated Partial Thromboplastin Time (aPTT) and Prothrombin Time (PT). In the Child classification for liver cirrhosis the coagulation as expressed by the PT is one of the determinants. Recently a test has become available which will make it possible to routinely measure the endogenous thrombin generation potential (ETP) which may be a better alternative. In this test according to the method first described by Hemker (1993) thrombin generation is continuously measured by use of a chromogenic substrate. Results are calculated as area under the curve and as a percentage of normal. We analysed 110 patients with liver cirrhosis classified according to the Child classification, 79 patients with stage A, 19 stage B and 12 stage C, without known pre-existing coagulation abnormalities like inherited bleeding disorders, or anticoagulant drugs. In these patients ETP, APTT, PT/INR, FV, FVII and FXI were measured. We used a fully automated assay for the determination of the endogenous thrombin potential (ETP) on the BCS® System (both Dade Behring, Marburg, Germany). The results for the mean PT were 81% (CI95 77 - 85) for Child A patients, 53% (CI95 44 - 63) for Child B, and 41% (CI95 33 - 50) for Child C. For the mean INR the results were 1.11 (CI95 1.08 - 1.14) for Child A patients, 1.65 (CI95 1.22 - 2.08) for Child B, and 1.82 (CI95 1.34 - 2.31) for Child C. The results for the mean normalized ETP were 0.87 (CI95 0.84 - 0.90) for Child A patients, 0.78 (CI95 0.68 - 0.88) for Child B, and 0.58 (CI95 0.51 - 0.64) for Child C (p