Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Gastroenterol Hepatol. 2009 Jun;24(6):992-7. doi: 10.1111/j.1440-1746.2008.05761.x. Epub 2009 Feb 12.
Non-cirrhotic portal hypertension due to extrahepatic portal vein thrombosis (EHO) and non-cirrhotic portal fibrosis (NCPF) is a major cause of upper gastrointestinal hemorrhage in India. Hypercoagulability has been proposed to explain the thrombosis in the portal vein in EHO and intrahepatic portal vein radicals in NCPF. However, some authors have reported hypocoagulability in these patients. Thromboelastography (TEG), which gives a dynamic assessment of coagulation, has potential for evaluating coagulation in these patients but has not been used so far. It was the aim of this study to evaluate the coagulation status in patients of EHO and NCPF using TEG.
Thirty patients with EHO and 19 patients with NCPF were studied. TEG was done in all patients. R (reaction time), K (constant), alpha (angle), MA (maximal amplitude), A 60 (width of tracing after 60 min) were recorded and TEG index calculated and compared to controls.
Seven patients (23.3%) in the EHO group and eight (42.1%) in the NCPF group had severe thrombocytopenia (platlets, < 50 000 cells/dL). TEG showed significantly shorter R, higher MA and larger A in both EHO and NCPF compared to controls (P < 0.01). Thrombocytopenia normalized A but R continued to be significantly shorter in EHO and NCPF. Overt hypercoagulability (TEG index, > +2.5) was seen in two patients with EHO and one patient with NCPF.
A latent hypercoagulable state exists in patients with EHO and NCPF which is partially masked by the thrombocytopenia secondary to splenomegaly and hypersplenism.
由于肝外门静脉血栓形成（EHO）和非肝硬化性门静脉纤维化（NCPF）导致的非肝硬化性门静脉高压是印度上消化道出血的主要原因。血栓形成被认为与 EHO 中的门静脉和 NCPF 中的肝内门静脉分支中的高凝状态有关。然而，一些作者报道这些患者存在低凝状态。血栓弹力图（TEG）可动态评估凝血功能，具有评估这些患者凝血功能的潜力，但尚未得到应用。本研究旨在通过 TEG 评估 EHO 和 NCPF 患者的凝血状态。
研究纳入 30 例 EHO 患者和 19 例 NCPF 患者。所有患者均进行 TEG 检查。记录 R（反应时间）、K（常数）、α（角度）、MA（最大振幅）、A 60（60 分钟后轨迹的宽度），并计算 TEG 指数与对照组进行比较。
EHO 组 7 例（23.3%）和 NCPF 组 8 例（42.1%）患者存在严重血小板减少症（血小板 < 50 000 细胞/dL）。与对照组相比，EHO 和 NCPF 患者的 TEG 显示 R 明显缩短、MA 明显升高和 A 明显增大（P < 0.01）。血小板减少症使 A 正常化，但 R 在 EHO 和 NCPF 中仍明显缩短。2 例 EHO 患者和 1 例 NCPF 患者出现明显高凝状态（TEG 指数> +2.5）。
EHO 和 NCPF 患者存在潜在的高凝状态，这种状态部分被脾肿大和脾功能亢进引起的血小板减少所掩盖。
