Study on the Mechanisms of Coagulation Abnormalities in Portal Vein Thrombosis in Patients with Liver Cirrhosis

Background: This study aims to investigate the mechanisms of coagulation abnormalities in portal vein thrombosis (PVT) in patients with liver cirrhosis by collecting portal and peripheral venous blood samples through interventional methods. The differences in lipopolysaccharide (LPS), Factor VIII (FⅧ), von Willebrand factor (vWF), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), soluble P-selectin (sPS), and soluble CD40 ligand (sCD40L) levels between patients with liver cirrhosis and PVT and those without PVT were analyzed. Methods： A total of 40 patients diagnosed with liver cirrhosis and undergoing transjugular intrahepatic portosystemic shunt (TIPS) treatment at Hebei Provincial People's Hospital from April 2022 to October 2024 were enrolled. According to the diagnostic criteria for PVT in liver cirrhosis, patients were divided into the PVT group (n=16) and the non-PVT group (n=24). General patient information and relevant laboratory tests were collected, and differences in age, gender, etiology, medical history, body mass index (BMI), and laboratory test indicators between the two groups were compared. Portal and peripheral venous blood samples were collected through TIPS, and LPS, FⅧ, vWF, ADAMTS13, sPS, and sCD40L concentrations were measured using ELISA. The levels of these indicators in the portal and peripheral veins were compared between the PVT and non-PVT groups, and correlation analyses were performed between LPS and FⅧ, vWF, ADAMTS13, sPS, and sCD40L. Results： 1.There were no significant differences between the PVT and non-PVT groups in age, gender, BMI, etiology, smoking history, alcohol consumption history, diabetes history, Model for End-Stage Liver Disease (MELD) score, white blood cell (WBC) count, neutrophil (NEUT) count, monocyte (MONO) count, lymphocytes (L), hemoglobin (Hb) level, platelet (PLT) count, albumin (ALB) level, alanine aminotransferase (ALT) level, aspartate aminotransferase (AST) level, prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT), and thrombin time (TT) (P>0.05). However, there were significant differences between the two groups in the fibrinogen (FIB) level, and D-dimer level (P<0.05)；2.In patients with liver cirrhosis, the levels of LPS, FⅧ, vWF, sPS, and sCD40L in portal venous blood were higher than those in peripheral venous blood, while the level of ADAMTS13 was lower. These differences were statistically significant (P<0.05). Similar differences were observed in patients with liver cirrhosis and PVT. Furthermore, the levels of LPS, FⅧ, vWF, sPS, and sCD40L in portal venous blood were higher in patients with liver cirrhosis and PVT than in those without PVT, while the level of ADAMTS13 was lower. These differences were also statistically significant (P<0.05). Additionally, among the 40 patients with liver cirrhosis, FⅧ, vWF, sPS, and sCD40L were significantly correlated with LPS (P<0.05), while there was no significant correlation between ADAMTS13 and LPS (P>0.05). A significant correlation was observed between vWF and ADAMTS13 (P<0.05). Conclusions: Endotoxemia in patients with portal vein thrombosis in cirrhosis can activate the endothelial damage and platelet activation mechanism of the portal vein system, and then lead to local coagulation dysfunction, which plays an important role in the formation of portal vein thrombosis in cirrhosis.