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The primary haemostasis is more preserved in thrombocytopenic patients with liver cirrhosis than cancer

Vinholt, Pernille, Justa,b; Alnor, Anne, B.b; Nybo, Madsa; Hvas, Anne-Mettec

Blood Coagulation & Fibrinolysis: April 2018 - Volume 29 - Issue 3 - p 307–313
doi: 10.1097/MBC.0000000000000725
ORIGINAL ARTICLES
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In thrombocytopenia, differences in haemostatic capacity may explain discrepancies in bleeding risk between patients with cancer and patients with liver cirrhosis. The objective was to compare the haemostatic capacity in different thrombocytopenic patient populations. We evaluated platelet aggregation using impedance aggregometry (Multiplate Analyzer), von Willebrand factor antigen (VWF:Ag), VWF:ristocetin-cofactor activity (VWF:RCo), activated partial thromboplastin time (aPTT), coagulation factor VIII, fibrinogen, and thrombin generation in adult hospitalized patients with platelet count less than 80 × 109/l. Patients either had liver cirrhosis (n = 28), or cancer (n = 169; n = 49 had haematological cancer) with no difference among patients with liver cirrhosis and cancer. Median platelet count was 48 × 109/l [interquartile range (IQR) 32–63 × 109/l]. Median platelet aggregation was higher in patients with cirrhosis than cancer, 416 AU × min (IQR 257–676) versus 145 AU × min (IQR 50–326) for collagen-induced platelet aggregation, P < 0.001. There was no difference in activated partial thromboplastin time (aPTT), coagulation factor VIII, or thrombin generation between the patient groups. Fibrinogen activity was higher in patients with cancer compared with patients with cirrhosis [12.5 μmol/L (IQR 9.9–16.5) versus 7.2 μmol/l (IQR 5.6–10.2)], P < 0.003. Patients with liver cirrhosis had a more preserved primary haemostasis compared with patients with cancer.

aDepartment of Clinical Biochemistry and Pharmacology, Odense University Hospital

bDepartment of Clinical Immunology and Biochemistry, Vejle Hospital, Vejle

cDepartment of Clinical Biochemistry, Aarhus University Hospital, Denmark

Correspondence to Anne B. Alnor, MD, Departmnt of Clinical Immunology and Biochemistry, Vejle Hospital, Beriderbakken 4, DK-7100 Vejle, Denmark Tel: +45 2225 8460; e-mail: anne.alnor@rsyd.dk

Received 10 November, 2017

Revised 20 February, 2018

Accepted 22 February, 2018

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