PROLONGED BLEEDING-TIME IN CIRRHOTIC-PATIENTS - RELATIONSHIP TO PERIPHERAL VASODILATION AND SEVERITY OF CIRRHOSIS

A prolonged bleeding time (>540 s), measured with a Simplate single te mplate device, was found in 0% of 50 patients with chronic hepatitis a nd 38% of 154 cirrhoric patients. Cirrhotic patients with a prolonged bleeding time (n = 59) had lower platelet counts (P < 0.001) and a lon ger prothrombin time (P < 0.001) and activated partial thromboplastin time (P < 0.001) compared with cirrhotic patients with a normal bleedi ng time (n = 95). A weak but significant negative correlation existed between the bleeding time and platelet count in cirrhotic patients (n = 154, r = -0.3668, P < 0.001). Patients with decompensated cirrhosis had a longer bleeding time in comparison to patients with compensated cirrhosis (621 +/- 39 vs 478 +/- 27 s, respectively, P < 0.01). The pr olonged bleeding time was also discovered in 25% of 83 cirrhotic patie nts with a platelet count >80 x 10(9)/L and a prothrombin time <17 s ( usually taken as safe limits for invasive procedures). Twenty-seven of the 83 cirrhotic patients received a haemodynamic study by Swan-Ganz catheterization. A lower systemic vascular resistance was found in cir rhotic patients with an abnormal bleeding time than in cirrhotic patie nts with a normal bleeding time (844+/-57 vs 1171+/-60 dyne.s.cm(-5), respectively, P < 0.001), whereas both groups had similar hepatic veno us pressure gradient (16.2+/-1.2 vs 18.1+/-1.4 mmHg, respectively, P > 0.05). There was a significant negative correlation observed between systemic vascular resistance and bleeding time in cirrhotic patients w ith a platelet count >80 x 10(9)/L and a prothrombin time <17 s (n = 2 7, r = -0.63, P < 0.001). These results demonstrate that prolonged ble eding time is common in patients with cirrhosis. Peripheral vasodilati on is probably an important factor in addition to platelet counts and the severity of liver disease in determining the bleeding time in cirr hosis.