Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development q Maria Assunta Zocco 1, * , Enrico Di Stasio 2 , Raimondo De Cristofaro 1 , Marialuisa Novi 1 , Maria Elena Ainora 1 , Francesca Ponziani 1 , Laura Riccardi 1 , Stefano Lancellotti 1 , Angelo Santoliquido 1 , Roberto Flore 1 , Maurizio Pompili 1 , Gian Lodovico Rapaccini 1 , Paolo Tondi 1 , Giovanni Battista Gasbarrini 1 , Raffaele Landolfi 1 , Antonio Gasbarrini 1 1 Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy 2 Department of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Rome, Italy See Editorial, pages 632–634 Background/ Aims: Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a func- tion of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients. Methods: One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Vari- ables able to predict PVT development within 1 year were identified by means of multiple logistic regression. Results: The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development. Conclusions: Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrho- sis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis. Ó 2009 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Keywords: Thrombotic risk factors; Liver cirrhosis; MELD score; Portal vein thrombosis; Portal flow velocity 1. Introduction The liver has many haemostatic functions, including the synthesis of most coagulation factors and inhibitors as well as fibrinolytic factors [1,2]. The balance between procoagulant and anticoagulant factors is essential to avoid excessive thrombin generation under physiologi- cal conditions [3]. Therefore, it is not surprising that advanced liver disease results in a complex pattern of defects in haemostatic functions in the form of reduced synthesis of coagulation factors, inhibitors, and abnor- mal clotting factors, abnormalities of fibrinolytic 0168-8278/$36.00 Ó 2009 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.jhep.2009.03.013 Received 9 October 2008; received in revised form 19 February 2009; accepted 17 March 2009; available online 23 April 2009 Associate Editor: J. Bosch q The authors who have taken part in this study declared that they do not have anything to disclose regarding funding from industry or conflict of interest with respect to this manuscript. * Corresponding author. Tel.: +39 347 0597805; fax: +39 06 35502775. E-mail address: mariaazocco@hotmail.com (M.A. Zocco). Abbreviations: TRFs, thrombotic risk factors; PVT, portal vein thrombosis; AT, antithrombin; APA, antiphospholipid antibodies; MELD, Model for End-stage Liver Disease; LAC, lupus anticoagu- lant; INR, international normalized ratio; APTT, activated partial thromboplastin time; ELISA, enzyme-linked immunosorbent assay; PT, prothrombin time. www.elsevier.com/locate/jhep Journal of Hepatology 51 (2009) 682–689