Endogenous heparin-like activity detected by anti-Xa assay in infected cirrhotic and non-cirrhotic patients

Scand J Gastroenterol. 2004 Sep;39(9):830-6. doi: 10.1080/00365520410004433.


Background: Bacterial infections have been proposed as a trigger for portal hypertensive bleeding in cirrhotic patients. Endogenous low molecular weight heparinoids have been previously detected in vitro by heparinase-modified thromboelastography, but it is not known what type of heparinoids they are. The aim of this study was to assay anti-Xa concentrations to detect heparin activity in infected cirrhotics in vivo.

Methods: We evaluated 30 cirrhotic patients (15 with bacterial infection, 15 not infected) and 9 non-cirrhotic patients with bacterial infection. The anti-Xa assay was performed at the start of infection in all patients and after resolution of infection in 8 cirrhotics (5 to 10 days after starting antibiotics); thromboelastography (native and heparinase I-modified TEG) was performed in a subgroup of 11 cirrhotic patients with infection, 8 cirrhotics without infection and 8 non-cirrhotics with infection.

Results: Anti-Xa activity was detected in 9 of the 15 infected cirrhotics (60%) and only in 1 of 15 non-infected cirrhotics (6.7%) (P < 0.01). In the infected cirrhotic patients, a heparinase effect was shown in the heparinase I-modified TEG: k time (P < 0.01), alpha-angle (P < 0.01) and r time (P = 0.05), with no effect in the non-infected cirrhotics. Four of 9 (44%) infected non-cirrhotics were positive with the anti-Xa assay.

Conclusion: In cirrhotic patients, bacterial infections modify haemostasis by producing endogenous heparin-like substances which can inhibit the activated clotting factor X (factor Xa). In infected non-cirrhotics, anti-Xa activity can also be found.

MeSH terms

  • Adult
  • Analysis of Variance
  • Bacterial Infections / complications
  • Bacterial Infections / diagnosis*
  • Case-Control Studies
  • Factor Xa / metabolism*
  • Female
  • Heparin / analysis
  • Heparin / metabolism*
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnosis*
  • Liver Function Tests
  • Male
  • Middle Aged
  • Probability
  • Prognosis
  • Reference Values
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Thrombelastography / methods


  • Heparin
  • Factor Xa