Patients with
liver cirrhosis and diminished
prothrombin activity (PA) have decreased levels of factor (F)VII coagulation activity (
FVII:C) and an increased
bleeding tendency. Whether this is also true of cirrhotic patients with normal PA is unknown. This study measured
FVII:C levels in such patients and investigated the correlation between altered
FVII:C levels and
bleeding tendency. Fifteen of 41 patients (37%) had decreased
FVII:C levels. Of these, the Child-Pugh score of liver function was A (n = 9), B (n = 5) and C (n = 1), compared to A (n = 25) and B (n = 1) in patients with normal
FVII:C values (chi2 = 8.88, P = 0.012). Bleeding time was significantly prolonged in 9/15 patients (60%) with impaired
FVII:C activity, compared to 3/26 (12%) patients with normal
FVII:C values (relative risk: 5.2, 95% CI: 1.7-16.6; P = 0.003). In conclusion,
liver cirrhosis patients may show impaired
FVII:C levels despite normal PA. In those with decreased
FVII:C activity, prolonged bleeding time is hypothesized to arise from an alteration in platelet activation due to FVII deficiency and diminished platelet count.
Bleeding risk should be evaluated, regardless of platelet count, before these patients are subjected to invasive diagnostic or
surgical procedures.