Bleeding in cirrhotic patients: a precipitating factor due to intravascular coagulation or to hepatic failure?

Haemostasis. 1983;13(5):328-34. doi: 10.1159/000214772.


In 24 cirrhotic patients at different stages of hepatic failure, factor VIII:C (F VIII:C), factor VIIIR:AG (F VIIIR:AG), factor VIII AG/C ratio (F VIII AG/C), and serum fibrin-fibrinogen degradation products (FDP) were investigated. In 11 of the 24 patients, several instances of gastrointestinal bleeding due to esophageal varices rupture were documented and 5 patients died of unarrestable bleeding. In our study, we evaluated whether the cause of bleeding was the development of intravascular coagulation or the severity of hepatic failure. A statistically significant difference between F VIII:C, F VIIIR:AG/C ratio, and serum FDP was found in bleeding in comparison with non-bleeding patients. An inverse correlation between the F VIII:C plasma level and serum FDP as well as a direct correlation between F VIII AG/C ratio and serum FDP in the group of bleeding patients were also found. These data seem to suggest a hypercoagulable state which was more significant in the 5 patients who died owing to bleeding. Furthermore, only 1 of these patients had severe hepatic failure. From this study it appears that, in cirrhotic patients, bleeding is related more to the appearance of disseminated intravascular coagulation, as a consequence of both hemodynamic and endothelial changes, than to the degree of hepatic failure itself.

MeSH terms

  • Adult
  • Antigens / analysis
  • Disseminated Intravascular Coagulation / complications
  • Factor VIII / analysis
  • Factor VIII / immunology
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Gastrointestinal Hemorrhage / etiology*
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / metabolism
  • Male
  • Middle Aged
  • von Willebrand Factor


  • Antigens
  • Fibrin Fibrinogen Degradation Products
  • von Willebrand Factor
  • Factor VIII