Cirrhosis is associated with complex
hemostatic modifications. Most
coagulation factors, either procoagulants or
anticoagulants, are reduced. Conventional coagulation tests (prothrombin time, activated partial thromboplastin time) don't allow to precisely identify the thrombotic risk as they are not sensible to coagulation inhibitors deficiencies. The aim of this study was to evaluate the coagulation in a population of cirrhotic patients using thrombinography. We analyzed the plasma samples from 30 cirrhotic patients (10 Child
A, 10 Child B, Child C 10) compared to 10 healthy controls using thrombinography with and without
thrombomodulin to sensiblise this test at the activated
protein C pathway. The results of endogenous
thrombin potential, the main parameter, expressed as a ratio (thrombinography with/without
thrombomodulin) were significantly higher in cirrhotic patients (0.69 ± 0.16) than in controls (0.49 ± 0.10) which reflects a low sensibility to the action of
thrombomodulin. This resistance increases with the severity of the disease assessed by the Child-Pugh score, demonstrating a potential hypercoagulable state. The results of the thrombinography challenge the dogma that cirrhotic patients are naturally "anticoagulated." These results highlight the potential interest of the thrombinography in the detection and monitoring of
hypercoagulability in cirrhotic patient. Increasing
hypercoagulability with the severity of the disease seems to be correlated with clinical observations since the occurrence of
thrombosis is more common when
cirrhosis is at an advanced stage.