Association between prolonged bleeding time and gastrointestinal hemorrhage in 102 patients with liver cirrhosis: results of a retrospective study

Institute of Clinical Medicine I, "La Sapienza" University, Rome, Italy.

BACKGROUND: Gastrointestinal bleeding is a frequent complication of liver cirrhosis (LC) and represents an important warning sign of imminent death. Platelet dysfunction is an abnormality occurring prevalently in severe liver failure, and could well predispose to bleeding. METHODS: One hundred and two patients with liver cirrhosis diagnosed by needle liver biopsy were studied. According to the Child-Pugh classification, 23 were A class, 42 B class and 37 C class cases. Prothrombin activity, aPTT, fibrinogen, FDPs, XDP and platelet count were measured in each patient; bleeding time was measured in all but 17 of them. Forty (39%) had experienced gastrointestinal bleeding during the last 3 years (2 A class, 12 B class, 26 C class). RESULTS: Patients with a history of previous gastrointestinal bleeding showed lower values for prothrombin activity and fibrinogen, and higher percentage of elevated FDP and XDP levels; moreover, they presented lower platelet counts and more prolonged bleeding times than patients without gastrointestinal blood loss. CONCLUSIONS: While our findings confirm the relationship between hyperfibrinolysis and bleeding, the association between bleeding time prolongation and gastrointestinal blood loss suggests studying platelet function prospectively in LC in order to analyze its role, if any, in favoring hemorrhage activity.