Character of changes of system of a hemostasis at sick of a cirrhosis
Since there were doubts as to the causes of hemorrhagic complications in liver cirrhosis it is actual a topical study both pro- and anticoagulant hemostasis.Aim. To evaluate the hemostatic system in patients with liver cirrhosis.Material and methods. 190 patients with cirrhosis were under examination: 123 have gastrointestinal bleeding,67 - refractory ascites. 84 patients died during examination. The duration of examination was from 2-3 weeks to 2.5-3 years.Estimation of procoagulant unit include determining the number of platelets, prothrombin index, activated par- tial thromboplastin time, blood-coagulation factor F VIII, fibrinogen levels, “B” and D-dimer fibrinogen. Anti- coagulant system was evaluated by activity of coagulation inhibitor of protein C.Results. In 71.5 % of discharged patients with bleeding and 60.0% of deaths, the activity of blood-coagulation factor F VIII exceeded normal levels. Increased activity of F VIII in patients with ascites was at 66.7 % and92.0 %, respectively. In the dynamics of the percentage of patients with elevated F VIII in all groups increased, reaching 85.8 %-94.0 % (p<0.01).The activity of protein C anticoagulant factor for 71.4 %-88.0 % of patients, which hospitalized with complications of LC, was reduced, accounting for less than 70 %. Low activity of protein C remained in dynamics such as those discharged and deceased patients, 68.0 % and 75.0 %, respectively, at DH and 90.0 % -4.0 % - at ascites, (p <0.01). Confirmation of the presence of thrombophilia in cirrhotic patients is to determine the level of D-dimer. At75.0 %-97.0 % of patients hospitalized with complications of the LC, the content of D-dimer in serum at admission was 5-8 times higher among patients subsequently discharged and 8-12 times among the dead, not decreasing over time (p <0,01).Conclusions. 1. Hemostasis of compensated cirrhotic patients is characterized by an imbalance toward hy- percoagulation, as evidenced by the decrease in the activity of protein C with normal or increased activity of blood-coagulation factor FVIII.2. Decompensated patients have varying degrees of hypocoagulation severity characterized by laboratory thrombocytopenia, decrease of prothrombin index, fibrinogen, increase of APTT, production of fibrin degrada- tion products (D-dimer), which clinically defines hemorrhagic syndrome in liver cirrhosis.