Altered clot kinetics in patients with non-alcoholic fatty liver disease

Abstract

Background. Emerging evidence has linked the presence of non-alcoholic fatty liver disease (NAFLD) with an increased risk for cardiovascular events. We hypothesised that altered clot kinetics and platelet function may contribute to this increased risk. This study compared whole blood clotting kinetics in patients with 1) non-cirrhotic NAFLD (n = 28) and 2) healthy control subjects (n = 22).Methods. Clotting kinetics were assessed in whole blood using thromboelastography (TEG) and assessed for correlations with cardiovascular risk factors.Results. Clot kinetics in patients with NAFLD showed significantly stronger clot development (maximum amplitude (MA); 58.3 ± 6.3 mm vs. 52.0 ± 10.1 mm, p = 0.01) and reduced clot lysis in the presence of thrombin (35 ± 307 vs. 51 ± 267 clot lysis 30 minutes after MA, p = 0.03) compared to control subjects. Clot strength was independently positively associated with body mass index in NAFLD, but not in control subjects. There was a greater platelet contribution to clot strength in patients with NAFLD compared to controls despite similar platelet counts. There was no association between clot kinetics and features of the metabolic syndrome or presence of type 2 diabetes.Conclusion. Patients with NAFLD have disturbances in ex-vivo clot kinetics including increased clot strength and clots that are more resistant to thrombin-stimulated lysis.

Keywords

• Obesity
• Platelets
• Thrombosis
• Chronic liver disease
• NASH
• Thromboelastography