Coagulation abnormalities in patients with cirrhosis in a tertiary hospital Sangli : A prospective study

  • Sheetal M Sale
  • Vaibhav P Mane Bharati Vidyapeeth Deemed University Medical College And Hospital ,Sangli.
  • Vishrabdha R Pawar
  • Dajiram G Mote
  • Sushant N Mohite
  • Vanisha Dhaka
Keywords: Cirrhosis, Prothromobin, Clotting, Coagulation abnormalities, Chronic liver disease,


Background :  The clotting is a multistep process  comprised of sequence  of events of platelet plug formation , clotting process , clotting process termination and  clot removal .Synthesis of clotting factors  and clearance of their activation products took place in liver. The magnitude of clinical features and  coagulation abnormalities  will vary depending on liver dysfunction . Therefore  wide spectrum of abnormalities will be seen in patients of liver cirrhosis. Aims and Objectives :  To study the various coagulation abnormalities in liver cirrhosis patients.  Methodology : This 1 year  prospective  study was conducted in a tertiary hospital  for the evaluation of the frequency of coagulation abnormalities in patients with cirrhosis of liver. 82 patients presenting with cirrhosis of liver were selected and were evaluated for coagulation profile. The data was collected via questionnaire form and analyzed by SPSS (Statistical Packages for Social Sciences) version  The patients blood were tested for coagulation abnormalities including prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count . Results  :In the present study, out of  82, fifty  (60.9  %)   were males and 32  (39.1 ) %  were females. According to Child’s Pughs classification,37(45.12 % ) cirrhotic patients were in class A, 13 (15.85% ) in class B and 32 (39.02 % ) in class C. The PT was prolonged (mean + SD = 20.67  ± 4.12 sec)  in  44 (53.65 % ) patients, while38 (46.34 %)  patients had normal PT which was less than 14 seconds (mean + SD = 12.13 ± 1.01sec). Activated partial thromboplastin time was prolonged in47 (57.31 % )  patients, while35 (42.68 % ) patients had normal APTT which was less than 40 seconds (mean + SD = 33.05 ±  3.06 sec). PT and APTT were significantly raised in cirrhotic patients. Approximately 39%  CLD cases had decreased platelet count. Relative risk of GI bleeding with abnormal clotting tests in CLD cases were weakly positive for PT (RR = 1.02; 95% CI, 0.49-2.10), negative for aPTT (RR=0.83; 95% CI, 0.47-1.45), strongly positive for decreased platelet counts (RR = 1.96; 95% CI, 1.08-3.56) . Conclusion : Coagulation abnormalities are commonly seen in cirrhotic liver disease.Decreased platelet count and  increased PT and APTT are commonly seen in chronic liver disease. These parameters can be used as prognostic markers. DOI: 10.21276/APALM.1170

Author Biography

Vaibhav P Mane, Bharati Vidyapeeth Deemed University Medical College And Hospital ,Sangli.
Department Of PathologyAssociate Professor


1.Amitrano L, Guardascione MA, Brancaccio V, Balzano A. Coagulation disorders in liver disease. Semin Liver Dis 2002; 22: 83-96.
2.Peck Radosavljevic M. Review article: coagulation disorders in chronic liver disease. Aliment Pharmacol Ther 2007; 26 Suppl 1: 21-8.
3.Rverter JC. Abnormal hemostasis tests and bleeding in chronic liver disease: are they related? Yes. J Thromb heamost 2006; 4: 717-20.
4.Tripodi A. Tests of coagulation in liver disease. Clin Liver Dis 2009; 13: 55-61.
5.Thachil J. Relevance of clotting tests in liver disease. Postgrad Med J 2008; 84: 177-81.
6.Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60: 649-9.
7.Formen LM, Lucey MR. Predicting the prognosis of chronic liver disease: an evolution from child to MELD. Mayo end-stage liver disease. Hepatology 2001; 33: 473-5.
8.Garrison RN, Cryer HM, Howard DA, Polk HC. Clarification of risk factor for abdominal operations in patients with hepatic cirrhosis. Ann Surg 1984; 199: 648-55.
9.Hedner U, Erhardtsen E. Hemostatic disorders in liver disease. In: Schiff ER, Sorrell MF, Maddrey WC, editors. Diseases of the liver. Philadelphia: Lippincott Williams and Wilkins; 2003; pp 625-35.
10.Lechner K, Niessner H, Thaler E. Coagulation abnormalities in liver disease. Semin Thromb Hemost 1977; 4: 40-56.
11.Bashour FN, Teran JC, Mullen KD. Prevalence of peripheral blood cytopenias (hypersplenism) in patients with non-alcoholic chronic liver disease. Am J Gastroenterol 2000; 95: 2936-9.
12.Schepis F, Camma C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhotic should undergo endoscopic screening for esophageal varices detection? Hepatology 2001; 33: 333-8.
13.Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol 1999; 94: 3292-6.
14.Clinical and Laboratory Standards Institute (CLSI). Collection, transport and processing of blood specimens for testing plasma-based coagulation assays and molecular hemostasis assays; approved guideline. 5th ed.H21-A5. Pennsylvania USA; 2008.
15.Clinical and Laboratory Standards Institute (CLSI). Procedure for the Determination of Fibrinogen in Plasma; Approved Guideline.2nd ed.H30-A2.Pennsylvania, USA; 2001.
16.Bukhtiari N, Hussain T, Iqbal M, Malik AM, Qureshi AH, Hussain A. Hepatits B and C single and co-infection in Chronic liver disease and their effect on the disease pattern. J Pak Med Assoc 2003; 53: 136-40.
17.Nidegger D, Ragot S, Berthelemy P, Masliah C, Pilette C, Martin T, et al. Cirrhosis and bleeding: the need for very earlymanagement. J Hepatol 2003; 39: 509-14.
18.Patch D, Armonis A, Sabin C, Christopoulou K, Greenslade L, McCormick A, et al. Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding. Gut 1999; 44: 264-9.
19.Lecleire S, Di Fiore F, Merle V, Herve S, Duhamel C, Rudelli A, et al. Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients: epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol 2005; 39: 321-7.
20.Escorsell A, Bordas JM, Castaneda B, Liach J, Garcia-Pagan JC, Rodes J, et al. Predictive value of the variceal pressure response to continued pharmacological therapy in patients with cirrhosis and portal hypertension. Hepatology 2000; 31: 1061-7.
21.Dell'era A, Bosch J. Review article: the relevance of portal pressure and other risk factors in acute gastro-oesophageal variceal bleeding. Aliment Pharmacol Ther 2004; 20 Suppl 3: 8-15.
22.Lisman T, Bongers T, Adelmeijer J, Janssen H, de Maat M, de Groot P, et al. Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatology 2006; 44: 53-61.
Original Article