DECEPTIVE PROTHROMBIN AND ACTIVATED PARTIAL THROMBOPLASTIN TIMES IN ALCOHOLIC CIRRHOSIS

It is believed that perioperative hemorrhage, in the hepatoportal area , results from a coagulopathy. This study determined if this could be quantitated by a modified recalcification time (MRT) test developed in our laboratory. Unlike prothrombin (PT) and activated partial thrombo plastin times (APTT), the MRT is performed with whole blood to ensure the role of blood cells and chemicals (particularly tissue factor, a p otent procoagulant) in the coagulation process. Candidates for liver t ransplantation (n=11) were studied. Samples (5 mL) of citrated venous blood were obtained from the patients. Aliquots (1 mL) from these samp les were divided into groups of vials labeled C, S, and E. Groups C an d S received 20 mu L saline and group E, 20 mu L of saline containing 10 mu g of Escherichia coli endotoxin (055: B5W). Vial C was incubated for 10 minutes and vials S and E for 120 minutes, all at 37 degrees C . Then, the MRT was determined on 300 mu L of blood from each vial aft er adding 40 mu L of 0.1M calcium chloride. Mean MRT values (minutes+/ -standard deviation) for C (MRTC), for S (MRTS), and for E (MRTE) were compared with like values from healthy controls (n=29). Despite prolo nged PT and APTT values, MRI values were shortened in patients with ci rrhosis. This hypercoagulability detected by the MRT exonerates a hemo rrhagic coagulopathy and possibly implicates widened and thinned gaps in the walls of the portal venous tributaries as the cause of perioper ative hemorrhage.