Alterations of plasma coagulation factor XIII may contribute to bleeding disorders in patients with liver cirrhosis.
Standard clotting tests such as prothrombin time or activated thromboplastin time cannot detect factor XIII deficiency.
Therefore this deficiency may often be overlooked in clinical practice.
Dr Frank Tacke and colleagues from Germany defined factor XIII's clinical and prognostic role in chronic liver disease.
Factor XIII activities were assessed among various other parameters in 111 patients with chronic liver diseases.
|Factor XIII of less than 50% increased the risk of severe upper gastrointestinal bleed|
The patients were assessed for these parameters during evaluation for liver transplantation in a prospective study.
Unlike coagulation factors II, V or VII, factor XIII activity was maintained in the majority of patients with liver cirrhosis.
The researchers noted that factor XIII deficiencies occurred, although rarely, especially in Child C cirrhosis.
The team found that factor XIII levels correlated with liver's biosynthetic capacity.
Factor XIII levels also correlated with platelet count, global coagulation tests and other single coagulation factors.
Patients reporting a current systemic bleeding tendency at study entry had significantly reduced factor XIII.
In a 6-year follow-up, patients with factor XIII of less than 50% had a significantly increased risk of severe upper gastrointestinal bleed.
The team observed that a reduced factor XIII was associated with increased mortality.
Dr Tacke's team concludes, “Factor XIII deficiency is rare in patients with liver cirrhosis, but is associated with a clinical bleeding tendency and an unfavorable prognosis for future hemorrhages and survival.”