From the Guidelines
Liver-produced coagulation factors include factors II, V, VII, IX, X, and XI, as well as protein C and protein S.
Coagulation Factors
- Factors II, V, VII, IX, X, and XI are all liver-derived procoagulant factors, which can be diminished in patients with cirrhosis, leading to prolongation of the prothrombin time 1.
- Protein C and protein S are liver-derived anticoagulant factors, which can also be decreased in cirrhosis, contributing to a relatively hypercoagulable state 1.
Clinical Implications
- The balance of these factors is crucial in maintaining hemostasis, and alterations in their levels can lead to either bleeding or thrombotic complications in patients with liver disease 1.
- The use of viscoelastic tests, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), may help guide blood product transfusions and improve patient outcomes, but their role in predicting post-procedural bleeding is still being explored 1.
- Fibrinogen levels, which are also produced by the liver, can be decreased in patients with cirrhosis, particularly in those with advanced disease, and may be associated with an increased risk of bleeding 1.
From the Research
Liver-Produced Coagulation Factors
The liver plays a crucial role in the production of various coagulation factors, including:
- Fibrinogen
- Prothrombin (factor II)
- Factor V
- Factor VII
- Factor IX
- Factor X
- Factor XI
- Factor XII
- Protein C
- Protein S
- Antithrombin 2
Specific Coagulation Factors and Their Association with Liver Disease
Liver diseases, such as cirrhosis, can lead to abnormalities in blood coagulation, including decreased production of clotting factors and increased circulating fibrinolytic activity 3, 4
- Factors II, VII, X, and V are often affected in liver diseases, and their levels can be used to evaluate the degree of hepatocellular failure 3
- The liver's role in clearing activated enzymes involved in clotting or fibrinolysis can also be impaired in liver diseases, leading to a predisposition to thrombotic events 3, 5
Experimental Evidence and Clinical Implications
Experimental studies have shown that components of the coagulation cascade, such as coagulation factor Xa and thrombin, can drive profibrogenic events leading to hepatic fibrosis 5
- The measurement of blood coagulation factor synthesis in cultures of human hepatocytes can provide valuable insights into the mechanisms of liver disease and the development of cell-based therapies for blood coagulation factor deficiencies 2