Genetic and Acquired Thrombotic Factors in Chronic Hepatitis C

Poujol-Robert, Armelle; Rosmorduc, Olivier; Serfaty, Lawrence; Coulet, Florence; Poupon, Raoul; Robert, Annie
March 2004
American Journal of Gastroenterology;Mar2004, Vol. 99 Issue 3, p527
Academic Journal
OBJECTIVES: During the progression of chronic liver disease towards cirrhosis, morphological studies have shown a close association between parenchymal remodeling and obliterative lesions of intrahepatic small portal and hepatic veins. These lesions are highly suggestive of intrahepatic thrombotic events, which may have a key role in the pathogenesis of hepatic fibrosis. The aim of the study was to investigate thrombotic risk factors in chronic hepatitis C patients with different extent of liver fibrosis.METHODS: The following thrombotic factors were evaluated in 68 hepatitis C patients with prothrombin activity≥ 80% (34 consecutive patients with extensive fibrosis and/or cirrhosis compared with 34 consecutive patients without extensive fibrosis and/or cirrhosis): factor V Leiden, G20210A prothrombin mutation, antithrombin, protein C and S deficiencies, hyperhomocysteinemia, elevated factor VIII level, and lupus anticoagulant.RESULTS: Three thrombotic risk factors were significantly more frequent in patients with extensive fibrosis and/or cirrhosis than in those without extensive fibrosis: protein C deficiency present in 14 patients (41%) as compared with three patients (9%),; elevated factor VIII level present in 19 patients (56%) as compared with six patients (18%),; and hyperhomocysteinemia present in 10 patients (29%) as compared with two patients (6%),. The association of two or three prothrombotic factors was present in 19 patients (56%) with extensive fibrosis and/or cirrhosis as compared with one patient (3%) without extensive fibrosis and/or cirrhosis,p<0.001.CONCLUSION: Multiple thrombotic risk factors coexist frequently in patients with extensive fibrosis and early stage of cirrhosis. Their association with local inflammation could favor thrombotic events in the liver micro-circulatory bed.


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