Hyperhomocysteinemia and hypercoagulability in primary biliary cirrhosis

Abstract

AIM: To assess the hypercoagulability in PBC and  its relationship with homocysteine (HCY) and various components of the haemostatic system.

METHODS: We investigated 51 PBC patients (43F/8M; mean age: 63 ± 13.9 yr ) and 102 healthy  subjects (86 women/16 men; 63 ± 13 yr), and evaluated the haemo- static process in whole blood  by the Sonoclot analysis and the platelet function  by PFA-100 device. We then measured HCY  (fasting  and after methionine loading), tissue  factor (TF), thrombin-antithrombin complexes (TAT), D-dimer (D-D), thrombomodulin (TM), folic acid, vitamin B6 and B12 plasma levels. C677T 5,10-methyl- enetetrahydrofolate reductase  (MTHFR)  polymorphism was analyzed.

RESULTS: Sonoclot RATE values of patients were significantly (P < 0.001) higher than those of controls. Sonoclot time to peak values and PFA-100  closure times were comparable in patients and  controls. TAT, TF and HCY levels, both in the fasting and post-methionine loading, were significantly (P < 0.001) higher in patients than in controls. Vitamin  deficiencies were detected in 45/51 patients  (88.2%). The prevalence of the homozygous TT677 MTHFR genotype was significantly higher in patients (31.4%) than in controls (17.5%) (P < 0.05). Sonoclot RATE values correlated significantly with HCY levels and TF.

CONCLUSION: In PBC, hyper-HCY is related to  hypo- vitaminosis and genetic predisposing factors.  Increased TF and HCY levels and signs of endothelial activation are associated with hypercoagulability and may have an important role in blood clotting activation.

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