Impact of sustained virus elimination on natural anticoagulant activity in patients with chronic viral hepatitis C

Aida Saray; Rusmir Mesihović; Zora Vukobrat-Bijedić; Srđan Gornjaković; Nenad Vanis; Amila Mehmedović; Vedad Papović; Sanjin Glavaš

doi:10.17305/bjbms.2013.2370

Authors

Aida Saray Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Rusmir Mesihović Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Zora Vukobrat-Bijedić Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Srđan Gornjaković Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Nenad Vanis Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Amila Mehmedović Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Vedad Papović Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University
Sanjin Glavaš Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University

DOI:

https://doi.org/10.17305/bjbms.2013.2370

Keywords:

chronic hepatitis C, liver disease, interferon alpha, anticoagulation proteins, Protein C, Protein S

Abstract

Previous studies have reported reduced synthesis of various hemostatic factors in patients with chronic liver disease. Whether changes in plasma levels of these proteins reflect recovered liver synthetic function following virological eradication therapy has not been approved yet. The aim of the study was to determine the impact of sustained viral suppression achieved with pegylated interferon alpha and ribavirin on hemostatic parameters including natural anticoagulants in patients with chronic hepatitis C.

The following coagulation screening tests were obtained in thirty patients with chronic viral hepatitis C before and after completion of antiviral treatment: activated partial thromboplastin time, prothrombin time, plasma fibrinogen and natural anticoagulant proteins antithrombin III, protein C (PC) and total protein S (PS) activity. Only patients who achieved durable virus suppression were included.

The mean PC and PS levels were significantly lower in patients with chronic viral hepatitis C before antiviral therapy than in healthy controls (79.04 ± 16.19 % vs. 109.92 ± 21.33% and 54.04 ± 16.11% vs. 87.60 ± 8.15%, respectively; (p<0.001). Mean levels of PC exhibited a significant increase by 14.69 % after the completion of antiviral treatment (93.73 ± 14.18%, p<0.001) as well as PS levels, which significantly increased by 21.46% (75.50 ± 15.43, p<0.001) when compared with pre-treatment values. No remarkable fluctuations in other hemostatic parameters were noted.

Protein C and protein S are sensitive markers of hepatocyte synthetic impairment and are valuable markers in monitoring the efficacy of antiviral treatment in chronic hepatitis C patients. Larger studies are needed to confirm our results.