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Inicio Annals of Hepatology O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS
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Vol. 24. Núm. S1.
Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
(septiembre 2021)
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Vol. 24. Núm. S1.
Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
(septiembre 2021)
Open Access
O-25 BACTERIAL INFECTION ENHANCES THROMBIN GENERATION IN PATIENTS WITH CIRRHOSIS
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Marina Pamponet Motta1, Elbio Antonio D'Antonio D'Amico2, Tânia Rubia Flores da Rocha2, Beatriz Yuri Migita1, Juliana Medeiros Batista1, Caroline Marcondes Ferreira1, Flair José Carrilho1, Alberto Queiroz Farias1
1 Department of Gastroenterology, University of Sao Paulo School of Medicine
2 Coagulation Laboratory, Division of Hematology, University of Sao Paulo School of Medicine
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Vol. 24. Núm S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Introduction and Aims

Current concept of coagulopathy in cirrhosis indicates that there is a rebalancing of hemostasis with plasma hypercoagulability. Bacterial infection can promotes releases of endothelial heparinoids. However, the effect of this condition on the thrombin generation is unknown. Our aim was to assess the effect of bacterial infection on thrombin generation in cirrhosis.

Methods

36 patients with cirrhosis and bacterial infection (infected group) were evaluated within 24 hours after start antibiotic and at least 5 days after infection resolution. 28 patients with decompensated cirrhosis and not infected (not infected group) were also enrolled and reevaluated, without any intervention between evaluation times. Primary endpoint was the effect of bacterial infection on thrombin generation (TG) parameter ETP with TM (ETP TM). TM is a protein C activator added to mimic in vivo conditions. ROTEM assays, INTEM and HEPTEM (heparinase modified), was performed to evaluate the endogenous heparinoids effect. Protein C (PC) and antithrombin (AT) assays were performed. All results were compared within each group between evaluation times.

Results

ETP TM values in infected cirrhotics were significantly higher than after resolution of infection (from 1145.4 ± 360.7 nmol/L*min to 958.1 ± 254.8 nmol/L*min, p=0.005) - figure 1. A heparinoid effect was found only in infected cirrhotics, with CTINTEM duration significantly longer than CTHEPTEM (p=0.004). This effect disappeared after resolution of infection (p=0.75). PC and AT deficiencies were significantly more severe in infected patients (p<0,01). RNI/TP, aPTT was worsen at active infection (p<0.05). None of these parameters exhibited a significant difference between inclusion and revaluation times in not infected group.

Conclusion

patients with cirrhosis exhibits significant higher amount of TG during bacterial infection and it is associated with reduction of PC and AT levels. Despite the endogenous heparinoid effect during infection in cirrhosis, plasma hypercoagulability is preserved and cannot be assessed by conventional coagulation tests.

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