From the Guidelines
Passive hepatic congestion due to heart failure can indeed affect Prothrombin Time (Protime), as evidenced by elevated prothrombin time and prolonged international normalized ratio (INR) in patients with Fontan-associated liver disease (FALD) 1.
Key Findings
- In the non-cirrhotic phase of FALD, passive congestion is associated with elevated prothrombin time and prolonged INR 1.
- However, there is no direct evidence in the provided study to suggest that passive hepatic congestion affects Activated Partial Thromboplastin Time (APTT).
Clinical Implications
- The liver's synthetic protein function may fail in advanced FALD, leading to decreased albumin levels 1.
- Addressing liver function is challenging in this population, as commonly employed scores (e.g., MELD and Child-Pugh classification) may reflect liver function poorly 1.
- MELD-XI score has demonstrated a significant correlation with histologically proven liver fibrosis, although a specific cut-off value for severe liver fibrosis has not been identified 1.
- It is essential to consider the potential effects of passive hepatic congestion on coagulation parameters, such as prothrombin time, when managing patients with heart failure.
From the Research
Effect of Passive Hepatic Congestion on Coagulation Tests
- Passive hepatic congestion due to heart failure can lead to liver dysfunction, which may affect coagulation tests such as Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (Protime) 2, 3.
- Liver disease is associated with impairment of haemostatic function due to abnormal and decreased synthesis of clotting factors, which can lead to abnormalities in coagulation tests 2.
- However, the use of PT and APTT as markers of bleeding in liver disease has been questioned, and their interpretation can be problematic 2, 4.
Relationship Between Heart Failure and Liver Dysfunction
- Heart failure can cause passive venous congestion of the liver, leading to liver damage and dysfunction 5, 3.
- Congestive hepatopathy (CH) and acute cardiogenic liver injury (ACLI) are two forms of liver damage caused by cardiac disorders, and they can have distinct laboratory findings and prognostic implications 5.
- The liver plays a crucial role in the pathophysiology of heart failure, and liver congestion can have important prognostic significance 6.
Coagulation Tests in Liver Disease
- Prothrombin Time (PT) is a universal indicator of liver disease severity, but its results can be variable due to differences in thromboplastin reagents 4.
- The use of international normalized ratio (INR) or activity percentage expression may help standardize PT results in patients with liver failure 4.
- However, the relationship between coagulation tests and liver congestion in heart failure patients is not fully understood and requires further research 6.