Measurement of the procoagulant activity of factor VII in patients with liver cirrhosis and normal prothrombin activity: evaluation of the bleeding risk

Patients with liver cirrhosis and diminished prothrombin activity (PA) have decreased levels of factor (F)VII coagulation activity (FVII:C) and an inc reased bleeding tendency. Whether this is also true of cirrhotic patients w ith normal PA is unknown. This study measured FVII:C levels in such patient s and investigated the correlation between altered FVII:C levels and bleedi ng tendency. Fifteen of 41 patients (37%) had decreased FVII:C levels. Of t hese, the Child-Pugh score of liver function was A (n = 9), B (n = 5) and C (n = I), compared to A (n = 25) and B (n = 1) in patients with normal FVII :C values (chi(2) = 8.88, P = 0.012). Bleeding time was significantly prolo nged 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 p rolonged bleeding time is hypothesized to arise from an alteration in plate let activation due to FVII deficiency and diminished platelet count. Bleedi ng risk should be evaluated, regardless of platelet count, before these pat ients are subjected to invasive diagnostic or surgical procedures. Blood Co agul Fibrinolysis 11 (suppl 1):S95-S99 (C) 2000 Lippincott Williams & Wilki ns.