Laboratory tests of hemostasis. The relation to hemorrhage in liver disease

Abstract

Coagulation studies were performed on a consecutive series of cirrhotics. Forty-one (70%) of 59 patients studied had an abnormal ( 60%) prothrombin time. Nineteen patients had clinical bleeding; each had an abnormal prothrombin time. Further studies performed on the 19 bleeders and 22 nonbleeders with abnormal prothrombin times revealed that plasma thromboplastin component (PTC, factor DC) deficiency was significantly more frequent and severe in bleeders. Determination of specific factor levels (n, V, VII, and X), euglobulin lysis time, platelet count partial thromboplastin, plasma recalcification, and thrombin times did not help to distinguish between bleeders and nonbleeders. Phytonadione administration led to prothrombin time improvement (> 60%) in 12 (37%) of 33 patients treated; none of the 12 bleeders, who were treated responded to phytonadione. Although hemostatic abnormalities may only be a reflection of severe liver disease, the constant relationship of hemorrhage with prothrombin complex and PTC deficiencies (refractory to phytonadione therapy) noted in the present study suggests that treatment of these abnormalities (with fresh blood or plasma) in bleeding cirrhotics should be continued until definitely proved to be of no value.