P-8 PRESERVATION OF THROMBIN GENERATION IN CIRRHOSIS DESPITE ABNORMAL RESULTS OF INTERNATIONAL NORMALIZED RATIO: IMPLICATIONS FOR INVASIVE PROCEDURES

Introduction

Thrombin generation (TG) is normal or elevated in patients with cirrhosis when tested in the presence of thrombomodulin (TM), the activator of the main natural anticoagulant protein C. However, the relationship between TG with bleeding has been little explored in literature.

Aims

To assess the relation among TG potential, measured without and in presence of TM, INR and the occurrence of bleeding after endoscopic band ligation of esophageal varices.

Patients and Methods

97 consecutive patients with cirrhosis were prospectively included (58 men; 54±10 years) and divided into two groups INR< 1.5 (n=72) or INR ≥1.5 (n=25). 46 healthy individuals were tested as controls. Endogenous thrombin potential (ETP) was measured without and with the addition of TM.

Results

ETP measured without TM was reduced in patients with cirrhosis when compared to controls, but no significant difference was found between the INR< 1.5 and INR ≥1.5 groups (1,250±315.7 versus 1,186±238 nmol/L x min; p= 0.3572). After addition of TM, both groups generated thrombin comparable to controls (INR ≥1.5: 965.9±232.3; INR<1.5: 893.0±368.6; controls: 915.0±458 nmol/L x min). 80% of patients had high ETP without/with TM ratio, indicating trend to hypercoagulability, which was more marked in the INR ≥1.5 group (0.81±0.1 versus 0.69±0.2; p=0.0042). Post-EVL bleeding occurred in 5.2% of the patients (INR<1.5, n=3; INR ≥1.5, n=2), all of them with ETP. without/with TM ratio ranging from 0.72 to 0.90 (controls 0.57±0.21).

Conclusions

This study shows that TG in the presence of TM was normal in most patients with cirrhosis, including those with high INR value, but did not correlate with post-EVL bleeding.

INR values and RETP values according to Child-Pugh class.