Naturally Occurring Anti-coagulant Proteins in Patients with Liver Cirrhosis: Is it Valuable Markers for Disease Severity?

Background: Hemostatic systems in cirrhotic patients are delicately balanced between pro- and anticoagulant factors and can be easily tipped to a hypo- or hypercoagulable status, resulting from decreased levels of procoagulant and anticoagulant factors synthesized by hepatocytes and sinusoidal cells. Hypercoagulability has an underestimated but crucial role in many aspects of LC and can encounter thrombotic complications.

Aim: Assessment of the activity of protein C, protein S and anti-thrombin III in patients with liver cirrhosis and their level with the degree of liver cirrhosis and to correlate the level of procoagulants markers (prothrombin concentration, prothrombin time) with the level of anticoagulant proteins in LC.

Methods: Case control study, included 136 patients were allocated into 3 groups according to Child Pugh scoring system as well as 44 apparently heathy persons as control group. All patients subjected to assessment of prothrombin time (PT), prothrombin concentration (PC), international normalized ratio (INR) and partial thromboplastin time (PTT) as well protein C, protein S and antithrombin III.

Results: Serum levels of protein C, protein S and Antithrombin III were significantly lower in the studied cases than controls and were significantly lower in patients with severe LC than in patients with mild LC. They negatively correlated with the disease severity and with levels of procoagulant markers.

Conclusion: Proteins C, protein S, and AT III decreased in patients with liver cirrhosis and its levels were correlated negatively to severity of liver disease as well as levels of procoagulant markers.