Abstract

Background: Chronic liver disease (CLD) is defined as a process of slow and continuous destruction and regeneration of the hepatic parenchyma giving rise to fibrosis and cirrhosis. When it has markedly progressed, it may present with clinical bleeding due to reduction in levels of procoagulant factors, barring some like factor VIII and von Willebrand factor, which are elevated. It is essential to observe that reduced levels of the procoagulants are accompanied by decrease in levels of anticoagulants such as antithrombin and protein C. Under normal conditions, the coagulation machinery is balanced, but the phenomenon of the simultaneous reduction of procoagulants as well as anticoagulants in patients with CLD has been an unsolved puzzle since long.
Objective: This study was undertaken to study the relevance and significance of first-line coagulation tests (prothrombin time [PT] and activated partial thromboplastin time [aPTT]) in relation to bleeding manifestations in patients with CLD, to classify the cases of CLD enrolled on the basis of etiology, to study the platelet count, PT, and aPTT values of the cases, and to calculate the Child–Pugh (CP) and model for end-stage liver disease (MELD) scores for all the patients and stratify them accordingly.
Materials and Methods: It was a prospective observational study including 40 patients known to be diagnosed with CLD. CP score and MELD were calculated for all. Values of coagulation parameters were compared in patients with and without cirrhosis, in patients belonging to different CP classes, those with low and high MELD scores, and patients with or without upper gastrointestinal (UGI) bleed.
Results: Means of PT and aPTT were compared in patients with and without cirrhosis where it was found that there was no statistically significant prolongation of PT or aPTT in patients with cirrhosis compared to those without. We also studied the values of PT and aPTT through increasing grades of CP score and found statistically significant difference between values of PT between those belonging to Class A versus Class C. It was observed that the difference of the mean of PT of the two groups (with MELD <15 and above 15) is statistically significant, whereas it is not true in case of aPTT.
Conclusions: The study showed no significant alterations overall in patients with CLD except those in advanced CP classes and those with high MELD scores. They were not significant in patients presenting with UGI bleed, a common manifestation in cirrhotic patients, although those constituted a very small part of the study group. These indices alone are insufficient to include as part of their prognostic and clinical work up to predict bleeding.