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

A. Zambruni, U. Thalheimer, J. Coppell, A. Riddell, A. Mancuso, G. Leandro, D. Perry, A. K. Burroughs

Research output: Contribution to journalArticlepeer-review


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), α-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.

Original languageEnglish
Pages (from-to)830-836
Number of pages7
JournalScandinavian Journal of Gastroenterology
Issue number9
Publication statusPublished - Sep 2004


  • Anti-Xa
  • Cirrhosis
  • Heparinoids
  • Infection
  • Thromboelastography

ASJC Scopus subject areas

  • Gastroenterology


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