Predicting the risk of portal vein thrombosis in patients with liver cirrhosis and hepatocellular carcinoma

Waleed Mohamed Serag,Bedoor Shehap Eldeen Mohammed,Magdy Mahmoud Mohamed,Basem Eysa Elsayed

doi:10.1016/j.heliyon.2020.e04677

Waleed Mohamed Serag, Bedoor Shehap Eldeen Mohammed + Show 2 more

Open Access

https://doi.org/10.1016/j.heliyon.2020.e04677

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Abstract

The mechanisms of the hypercoagulable state in cirrhotics with and without hepatocellular carcinoma are incompetently comprehended. Objective: We aimed to explore the plasma Annexin A5/PS + MP ratio in these patients. Higher levels of Annexin A5 and PhosphatidylSerine bearing microparticles have been observed in cases of inflammation and increased coagulation but there are no studies which explore if there is an association between them and PVT in cirrhotics with and without HCC. So, our goal is to estimate their role in predicting PVT within HCV cirrhotics with and without HCC. 91 HCV cirrhotics with and without HCC and 20 healthy people (controls) were enlisted. Cirrhotics with and without HCC who developed PVT displayed higher levels of PS + MPs and lower Annexin A5/PS + MPs ratio (38.73 ± 1.92) and (0.00238 ± 0.00047) than cirrhotics who didn't develop PVT (22.19 ± 10.58) and (0.00451 ± 0.0023) (P < 0.001). Among the tested factors, lower Annexin A5/PS + MPs ratio show higher performance in predicting PVT in total cirrhotics, AUC, 0.919 followed by PS + MPs level, 0.876, Portal flow velocity, 0.842, Plasma Annexin A5 level, 0.509. In our hypothesis, As phosphatidylserine exposure increase due to increased level of circulating microparticles in cirrhotics with and without HCC, anenxin-A5 may be secreted by platelets and endothelial cells into the circulation as a physiological response to inactivate the elevated levels of PS bearing MPs produced in these patients but the increase in anenxin-A5 level isn't equivalent to the increase in PS bearing MPs levels. The equilibrium between plasma annexin A5 and PS bearing MPs levels is defected.

Highlights

Portal vein thrombosis is the obstruction of the portal vein or its branches by a blood thrombus [1]
We hypothesized that disproportion between plasma annexin A5 and PhosphatidylSerine bearing microparticles (PS þ MPs) levels could at least slightly clarify this hypercoagulability
Our findings revealed that Plasma Annexin A5/MP ratio was significantly related to development of PVT in cirrhotics with and without HCC (Table 3)

Summary

Introduction

Portal vein thrombosis is the obstruction of the portal vein or its branches by a blood thrombus [1]. Studies have shown that we can prognosticate the progression of PVT in cirrhotsic from a hypercoagulable condition, decrease in the blood flow rate, endothelial cell injury, and cirrhosis complications, but the conclusions are incompatible [5]. Microparticles are extracellular vesicles extensively studied in hemostasis due to the capability to carry detected in hypertension patients [17] and in other cases related to increased coagulation states and inflammation such as SCD [18] and SLE [19]. Our goal was to examine the presence of PhosphatidylSerine bearing microparticles (PS þ MPs) and Annexin A5 in plasma of HCV cirrhotics with and without HCC and to explore if the lower plasma Annexin A5/PS þ MP ratio in these patients could predict the development of PVT

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