BLEEDING-TIME IN PATIENTS WITH CIRRHOSIS - RELATION WITH DEGREE OF LIVER-FAILURE AND CLOTTING ABNORMALITIES

Patients with cirrhosis suffer from a complex haemostatic disturbance, due to abnormalities in clotting and fibrinolytic system activation a nd in primary haemostasis. The latter is indicated by a prolongation o f bleeding time, which is a reliable indicator of platelet function in vivo. To further assess the relationship between bleeding time, degre e of liver failure and clotting abnormalities in patients with cirrhos is, bleeding time was investigated in a prospective study of 70 consec utive patients with cirrhosis diagnosed by liver-needle biopsy, of who m 19 belonged to Child-Pugh class A, 29 to B and 22 to C. Among patien ts with cirrhosis, 40% had an abnormal bleeding time (>10 min), and 42 % had a platelet count <100 000/mu l. Patients with severe liver failu re (class C) had a lower platelet count and a more prolonged bleeding time than patients in classes A and B. Bleeding time was significantly inversely correlated to platelet count, fibrinogen, prothrombin activ ity and packed cell volume, and directly correlated to serum bilirubin and D-dimer. However, in class C patients, only a significant inverse correlation between bleeding time and fibrinogen was observed. These findings indicate that in cirrhosis worsening of platelet function is closely related to the degree of liver failure. The inverse correlatio n between bleeding time and fibrinogen indicates that a low value of t his clotting parameter may account in part for platelet dysfunction. ( C) Journal of Hepatology.