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发表于 2002-9-20 22:12
Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study
Date: Tue, 17 Sep 2002 08:06:38 -0400
J Hepatol 2002 Oct;37(4):463
Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a
prospective study.
Montalto P, Vlachogiannakos J, Cox D, Pastacaldi S, Patch D, Burroughs A
Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, Pond
Street, NW3 2QG, London, UK
[Medline record in process]
BACKGROUND: Bacterial infections have been postulated as a trigger for
variceal bleeding in cirrhotic patients, and impair coagulation evaluated by
thrombelastography (TEG). Endogenous heparinoids have been detected after
variceal bleeding and during liver transplantation in some cirrhotics using
heparinase-modified-TEG.AIM: To assess if bacterial infection is associated
with endogenous heparinoids in cirrhotics, thus impairing
coagulation.METHODS: Native and heparinase-modified-TEG (cleavage of heparin
and heparan-sulphate) was performed in 60 cirrhotics (Grade A, 2; B, 30; C,
28): 30 infected [septicaemia, 6 (culture positive); 6 (culture negative);
spontaneous bacterial peritonitis, 10; chest infection, 4; others, 4], 30
not infected, and five infected patients without liver diseases, comparing
TEG parameters r, alpha, and ma. Eight cirrhotics were studied before and
after infection. The diagnosis of presence and type of infection was based
on international standard criteria.RESULTS: A significant heparin effect was
found only in infected cirrhotics (28 of 30) with significant changes in r
(P=0.0003), alpha (P<0.0001), and ma (P<0.0001), but in none of those not
infected. This effect completely reversed in the eight evaluated after
resolution of infection. There was no heparin effect in infected
non-cirrhotics.CONCLUSIONS: A heparin effect was only found in cirrhotic
patients with infection, further confirming that infection significantly
modifies coagulation in cirrhotic patients.
PMID: 12217599, UI: 22206795
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