Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis

Giordano Sigon, Roberta D'Ambrosio, Mariagrazia Clerici, Giuseppina Pisano, Veena Chantarangkul, Roberta Sollazzi, Rosa Lombardi, Flora Peyvandi, Pietro Lampertico, Silvia Fargion, Armando Tripodi, Anna Ludovica Fracanzani

Research output: Contribution to journalArticlepeer-review


Background & Aims: Patients with chronic HCV infection besides hepatitis often present cardiovascular damage, the pathogenesis of which is not defined. In chronic liver diseases, including NAFLD and cirrhosis, a procoagulant imbalance, potentially responsible for atherosclerosis has been reported. We aimed at evaluating whether a procoagulant imbalance is present also in non-cirrhotic patients with HCV infection and whether the procoagulant imbalance correlates with cardiovascular damage. The correlation between the procoagulant imbalance, coexisting steatosis, and liver fibrosis was analysed. Methods: From 2014 to 2018, 393 subjects (205 patients with chronic HCV infection from two liver units and 188 controls) were enrolled. Metabolic, cardiovascular, liver assessment and coagulation parameters—procoagulants (FII and FVIII) and anticoagulants (antithrombin and protein C [PC]), endogenous thrombin potential (ETP), peak-thrombin and their ratios (with/without thrombomodulin)—were determined. Results: The procoagulant imbalance (defined as high FVIII, FVIII/PC ratio, ETP-ratio and peak-thrombin-ratio (with/without thrombomodulin)) was significantly higher in patients with chronic HCV than controls. Steatosis was detected in 87 patients (42%). No difference in coagulation imbalance, carotid and cardiac parameters and severity of liver fibrosis was observed in patients with or without steatosis, despite the latter had less severe metabolic alterations. The FVIII/PC ratio was independently associated with carotid intima-media thickness (coefficient 0.04, 95% CI 0.002-0.07, P =.04) and liver fibrosis (coefficient 0.64, 95% CI 0.37-0.92, P <.0001). Conclusion: Patients with HCV infection, even in the absence of cirrhosis have a procoagulant-imbalance that possibly plays a role in increasing the risk of cardiovascular disease and progression of fibrosis.

Original languageEnglish
Pages (from-to)2309-2316
JournalLiver International
Issue number12
Publication statusPublished - 2019


  • cardiovascular disease
  • coagulation parameters
  • fatty liver
  • fibrosis
  • hepatitis C infection

ASJC Scopus subject areas

  • Hepatology


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