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Thromb Haemost 2023; 123(07): 714-722
DOI: 10.1055/a-2052-9381
Stroke, Systemic or Venous Thromboembolism

Increased Factor VIII Activity Is Predictive of the Occurrence of Portal Vein Thrombosis in Cirrhosis

Siyu Jiang   *
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
,
Yingjie Ai   *
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
,
Xiaowen Fan   *
2   Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, Florida, United States
,
Xiaoquan Huang
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
,
Ling Wu
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
,
Liyuan Ni
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
,
Feng Li
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
,
Shiyao Chen
1   Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
3   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
› Author Affiliations Funding This study was supported by Shanghai Sailing Program (No. 19YF1406500), the National Natural Science Foundation of China (No. 81900511), and Zhongshan Hospital Foundation (No. 2021ZSYQ03). The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Abstract

Background The aim of this study was to identify the role of factor VIII (FVIII) in portal vein thrombosis (PVT) occurrence in cirrhotic patients with gastroesophageal variceal bleeding.

Methods A total of 453 cirrhotic patients with gastroesophageal varices were enrolled. Computed tomography was performed at baseline and patients were divided into PVT and non-PVT groups (n = 131 vs. 322). Individuals without PVT at baseline were followed up for the development of PVT. Time-dependent receiver operating characteristic analysis of FVIII for PVT development was performed. The Kaplan–Meier methodology was used to analyze the predictive ability of FVIII for PVT incidence at 1 year.

Results FVIII activity (177.00 vs. 153.70, p = 0.001) was significantly increased in the PVT group compared with the non-PVT group in cirrhotic patients with gastroesophageal varices. FVIII activity was positively correlated with the severity of PVT (161.50 vs. 171.07 vs. 187.05%, p = 0.001). Furthermore, FVIII activity (hazard ratio [HR]: 3.48, 95% confidence interval [CI]: 1.14–10.68, p = 0.029 in model 1; HR: 3.29, 95% CI: 1.03–10.51, p = 0.045 in model 2) was an independent risk factor of 1-year PVT development in patients without PVT at baseline, which was confirmed by two separate Cox regression analysis and competing risk models. Patients with elevated FVIII activity exhibit a higher incidence of PVT in the non-PVT group at 1 year (15.17 vs. 3.16%, p < 0.001). The predictive value of FVIII remains significant in individuals who have never received splenectomy (14.76 vs. 3.04%, p = 0.002).

Conclusion Elevated FVIII activity was potentially associated with the occurrence and the severity of PVT. It might be helpful to identify cirrhotic patients at risk of PVT.

Keywords

cirrhosis - portal vein thrombosis - coagulation FVIII - portal hypertension - prognosis

Ethical Statement

Ethics Committee of Zhongshan Hospital of Fudan University approved the study protocol (B2015–133R). The study was conducted in accordance with the Helsinki Declaration as revised in 2013. Informed consent was obtained from all participants.


Data Availability Statement

All data included in this study are available upon request by contact with the corresponding author.


Authors' Contribution

S.J. analyzed, interpreted the data, and drafted the manuscript. Y.A. and X.F. undertook data analysis and revised the manuscript. X.H. conceived the study, collected and interpreted the data, and revised the manuscript. L.W. and L.N. helped with the data collection and analysis. F.L. helped with data interpretation and the revision of the manuscript. S.C. conceived the study and performed the critical revision of the manuscript. All authors were involved in the critical revision of the manuscript for important intellectual content.


* Siyu Jiang, Yingjie Ai, and Xiaowen Fan contributed equally to this manuscript.


Supplementary Material



Publication History

Received: 04 December 2022

Accepted: 01 March 2023

Accepted Manuscript online:
13 March 2023

Article published online:
04 April 2023

© 2023. Thieme. All rights reserved.

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