Abstract
Background and aims
Alteration of platelet status associates with decompensation and death in cirrhosis,
while its effect on portal vein thrombosis (PVT) remains unclear. We aimed to retrospectively
investigate whether PVT associates with platelet-fibrin clot strength and platelet
activation in decompensated cirrhosis.
Methods
Platelet-fibrin clot strength (G) was measured by thromboelastography (TEG). Platelet
activation was reflected by plasma concentrations of soluble p-selectin (sPs) and
a platelet aggregation test adjusted for platelet counts.
Results
Among 166 patients, 45 had PVT. The platelet count was significantly lower in PVT.
While the G value was positively correlated with platelet count (ρ = 0.74, P < 0.01), increased G was associated with PVT after adjusting for platelet count in
the logistic regression (P = 0.04). The normalized G value according to the linear relation with platelet count
was calculated as follows: Gplatelet = [(G - 2622)/platelet count]. This coefficient had no correlation with platelet
count and was an independent risk factor of PVT (OR = 1.03, CI95%: 1.01-1.05, P = 0.012). In two subanalyses, the collagen-induced platelet aggregation (n = 37,
P = 0.029) and plasma concentration of sPs (n = 56, P = 0.001) adjusted for platelet count were significantly higher in PVT.
Conclusion
This study showed a positive correlation of high platelet-fibrin clot strength detected
via TEG and platelet activation with PVT in decompensated cirrhosis.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- AGA clinical practice update: coagulation in cirrhosis.Gastroenterology. 2019; 157 (e31): 34-43https://doi.org/10.1053/j.gastro.2019.03.070
- Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case-control study.Hepatol Int. 2021; 15: 1183-1195https://doi.org/10.1007/s12072-021-10224-4
- De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes.Am J Gastroenterol. 2013; 108: 568-574https://doi.org/10.1038/ajg.2012.452
- Portal vein thrombosis in decompensated cirrhosis: rationale for treatment.Clin Transl Gastroenterol. 2019; 10: e00026https://doi.org/10.14309/ctg.0000000000000026
- Current knowledge and management of portal vein thrombosis in cirrhosis.J Hepatol. 2021; 75: 442-453https://doi.org/10.1016/j.jhep.2021.04.029
- Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study.Liver Int. 2018; 38: 94-101https://doi.org/10.1111/liv.13500
- Predicting portal thrombosis in cirrhosis: a prospective study of clinical, ultrasonographic and hemostatic factors.J Hepatol. 2021; 75: 1367-1376https://doi.org/10.1016/j.jhep.2021.07.020
- Factor VIII/protein C ratio independently predicts liver-related events but does not indicate a hypercoagulable state in ACLD.J Hepatol. 2022; 76: 1090-1099https://doi.org/10.1016/j.jhep.2021.12.038
- Viscoelastic tests in liver disease: where do we stand now?.World J Gastroenterol. 2021; 27: 3290-3302https://doi.org/10.3748/wjg.v27.i23.3290
- Thromboelastography-guided blood component use in patients with cirrhosis with nonvariceal bleeding: a randomized controlled trial.Hepatology. 2020; 71: 235-246https://doi.org/10.1002/hep.30794
- Thromboelastography parameters are associated with cirrhosis severity.Dig Dis Sci. 2019; 64: 2661-2670https://doi.org/10.1007/s10620-019-05597-4
- Reduced clot stability by thromboelastography as a potential indicator of procedure-related bleeding in decompensated cirrhosis.Hepatol Commun. 2021; 5: 272-282https://doi.org/10.1002/hep4.1641
- Thromboelastography better reflects hemostatic abnormalities in cirrhotics compared with the international normalized ratio.J Clin Gastroenterol. 2020; 54: 741-746https://doi.org/10.1097/MCG.0000000000001285
- Thromboelastometry hypercoagulable profiles and portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma.Dig Liver Dis. 2017; 49: 440-445https://doi.org/10.1016/j.dld.2016.12.019
- Systemic inflammation and portal vein thrombosis in cirrhotic patients with gastroesophageal varices.Eur J Gastroenterol Hepatol. 2020; 32: 401-405https://doi.org/10.1097/MEG.0000000000001526
- Association of thromboelastography profile with severity of liver cirrhosis and portal venous system thrombosis.BMC Gastroenterol. 2021; 21: 253https://doi.org/10.1186/s12876-021-01832-3
- Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: a prospective study.Liver Int. 2019; 39: 1459-1467https://doi.org/10.1111/liv.14121
- Thrombin-induced platelet-fibrin clot strength: relation to high on-clopidogrel platelet reactivity, genotype, and post-percutaneous coronary intervention outcomes.Thromb Haemost. 2014; 111: 713-724https://doi.org/10.1160/TH13-08-0643
- Assessing the methodology for calculating platelet contribution to clot strength (platelet component) in thromboelastometry and thrombelastography.Anesth Analg. 2015; 121: 868-878https://doi.org/10.1213/ANE.0000000000000859
- Increased platelet aggregation in patients with decompensated cirrhosis indicates higher risk of further decompensation and death.J Hepatol. 2022; 77: 660-669https://doi.org/10.1016/j.jhep.2022.03.009
- Role of portal venous platelet activation in patients with decompensated cirrhosis and TIPS.Gut. 2020; 69: 1535-1536https://doi.org/10.1136/gutjnl-2019-319044
- Low-grade endotoxemia and platelet activation in cirrhosis.Hepatology. 2017; 65: 571-581https://doi.org/10.1002/hep.28853
- Increased soluble GPVI levels in cirrhosis: evidence for early in vivo platelet activation.J Thromb Thrombolysis. 2017; 43: 54-59https://doi.org/10.1007/s11239-016-1401-0
- Acute kidney injury in decompensated cirrhosis is associated with both hypo-coagulable and hyper-coagulable features.Hepatology. 2020; 72: 1327-1340https://doi.org/10.1002/hep.31443
- Global hemostatic profiling in patients with decompensated cirrhosis and bacterial infections.JHEP Rep. 2022; 4100493https://doi.org/10.1016/j.jhepr.2022.100493
- Baveno VII - Renewing consensus in portal hypertension.J Hepatol. 2022; 76: 959-974https://doi.org/10.1016/j.jhep.2021.12.022
- Spontaneous portosystemic shunts in cirrhosis: detection, implications, and clinical associations.Dig Liver Dis. 2021; 53: 1468-1475https://doi.org/10.1016/j.dld.2020.11.020
- Platelet count/spleen volume ratio has a good predictive value for esophageal varices in patients with hepatitis B liver cirrhosis.PLoS One. 2021; 16e0260774https://doi.org/10.1371/journal.pone.0260774
- Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites.Gut. 2015; 64: 531-537https://doi.org/10.1136/gutjnl-2014-308874
- Strengths and weaknesses of light transmission aggregometry in diagnosing hereditary platelet function disorders.J Clin Med. 2020; 9https://doi.org/10.3390/jcm9030763
- Association between thrombogenicity indices and coronary microvascular dysfunction in patients with acute myocardial infarction.JACC Basic Transl Sci. 2021; 6: 749-761https://doi.org/10.1016/j.jacbts.2021.08.007
- Association of thrombelastographic parameters with post-stenting ischemic events.J Neurointerv Surg. 2017; 9: 192-195https://doi.org/10.1136/neurintsurg-2015-011687
- Stored platelet number and viscoelastic maximum amplitude are not altered by warming or rapid infusion.Transfusion. 2019; 59: 2997-3001https://doi.org/10.1111/trf.15446
- Platelet activation assessed by glycoprotein VI/platelet ratio is associated with portal vein thrombosis after hepatectomy and splenectomy in patients with liver cirrhosis.Clin Appl Thromb Hemost. 2018; 24: 254-262https://doi.org/10.1177/1076029617725600
- Risk factors of portal vein thrombosis after devascularization treatment in patients with liver cirrhosis: a nested case-control study.Biomed Res Int. 2020; 20209583706https://doi.org/10.1155/2020/9583706
- Improvement of human platelet aggregation post-splenectomy with paraesophagogastric devascularization in chronic hepatitis B patients with cirrhotic hypersplenism.Platelets. 2020; 31: 1019-1027https://doi.org/10.1080/09537104.2019.1704715
- Entecavir as a P2X7R antagonist ameliorates platelet activation and thrombus formation.J Pharmacol Sci. 2020; 144: 43-51https://doi.org/10.1016/j.jphs.2020.07.002
- Fibrinogen measurement in liver disease: validation of the functional fibrinogen thromboelastography assay and a novel mathematical predictive model.Blood Transfus. 2019; 17: 237-246https://doi.org/10.2450/2018.0105-18
- Platelet biology and functions: new concepts and clinical perspectives.Nat Rev Cardiol. 2019; 16: 166-179https://doi.org/10.1038/s41569-018-0110-0
- The pathophysiology of portal vein thrombosis in cirrhosis: getting deeper into virchow's triad.J Clin Med. 2022; 11: 800https://doi.org/10.3390/jcm11030800
- Shear-dependent platelet aggregation: mechanisms and therapeutic opportunities.Front Cardiovasc Med. 2019; 6: 141https://doi.org/10.3389/fcvm.2019.00141
- Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients.Dig Liver Dis. 2022; 54: 103-110https://doi.org/10.1016/j.dld.2020.12.114
- Platelet consumption and hyperreactivity coexist in experimental traumatic hemorrhagic model.Platelets. 2020; 31: 777-783https://doi.org/10.1080/09537104.2019.1678120
- Thrombin induced platelet-fibrin clot strength measured by thrombelastography is a novel marker of platelet activation in acute myocardial infarction.Int J Cardiol. 2014; 172: e24-e25https://doi.org/10.1016/j.ijcard.2013.12.092
Article Info
Publication History
Published online: October 21, 2022
Accepted:
September 30,
2022
Received:
May 16,
2022
Publication stage
In Press Corrected ProofFootnotes
Grant support: This study was supported by the Sichuan Science and Technology Program (Grant No. 22ZDYF0621), 1·3·5 project for disciplines of excellence – Clinical Research Incubation Project (2019HXFH024), West China Hospital, Sichuan University, Technological innovation R&D project of Chengdu Science and Technology Bureau (2021-YF05-01285-SN), National Natural Science Foundation of China (Grant No. 82270649) and Sichuan Science and Technology Program (2020YFS0236).
Conflict of Interest: The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
