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Reversal of hypercoagulability in patients with HCV ‐related cirrhosis after treatment with direct‐acting antivirals
Author(s) -
Russo Francesco Paolo,
Zanetto Alberto,
Campello Elena,
Bulato Cristiana,
Shalaby Sarah,
Spiezia Luca,
Gavasso Sabrina,
Franceschet Enrica,
Radu Claudia,
Senzolo Marco,
Burra Patrizia,
Lisman Ton,
Simioni Paolo
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13873
Subject(s) - medicine , cirrhosis , gastroenterology , thrombomodulin , incidence (geometry) , coagulopathy , platelet , thrombin , physics , optics
Background & Aims The long‐term impact of sustained virological response ( SVR ) after direct‐acting antivirals ( DAA s) on the hypercoagulability associated with HCV cirrhosis is unknown. We longitudinally evaluated the effect of DAA s treatment on cirrhotic coagulopathy. Methods Pro‐ and anticoagulant factor levels and thrombin generation were assessed in patients with HCV ‐related cirrhosis at baseline, end of therapy ( EOT ), at 12, 24 and 48 weeks (W) after EOT . Results Fifty‐eight patients were enrolled (86% Child’s A). SVR was 100%. Median factor VIII activity significantly decreased at EOT , 12 weeks and 24 weeks compared with baseline, whereas protein C significantly increased at 24 weeks and 48 weeks. Cirrhotic patients showed a slight but sustained increase in endogenous thrombin potential ( ETP ) with a statistically significant difference at EOT , 12 weeks, 24 weeks and 48 weeks compared with baseline. Conversely, thrombomodulin‐modified ETP was elevated before treatment and decreased over time to normal levels at 24 weeks and 48 weeks. The ETP ratio decreased slowly at EOT and 12 weeks, and was significantly decreased at 24 weeks and 48 weeks compared with baseline ( P < .001 for both comparisons), being not statistically different from ETP ratio measured in healthy controls. Child’s B patients showed a significantly higher ETP ratio compared to Child’s A at baseline and did not show any significant improvement in ETP ratio through 12 weeks. Two Child’s B patients developed PVT with an incidence rate of 1.1% p‐yrs (95% CI , 0.18 to 3.58). Conclusions DAA s therapy in HCV ‐related cirrhotic patients is associated with significant changes in thrombin generation suggesting a reversal of hypercoagulability particularly in Child’s A patients.