{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:41:45Z","timestamp":1765608105986,"version":"3.30.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":8005,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[1993,10]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>To assess the contribution of naturally occurring portal-systemic shunts to the coagulopathy of patients with liver disease, we studied laboratory parameters of hemostasis in 20 adult patients with extrahepatic portal hypertension, secondary to portal vein thrombosis, that had resulted in variceal bleeding. All extrahepatic portal hypertension patients had normal liver function and histological appearance. None had any evidence of preexisting coagulation disorders, and none had bled or undergone sclerotherapy in the 6 mo before study. Age- and gender-matched groups of 20 healthy individuals and 20 stable patients with cirrhosis and portal hypertension who had a history of variceal bleeding served as controls. Both patient groups had thrombocytopenia consistent with hypersplenism and portal hypertension. Prothrombin international normalized ratio (extrahepatic portal hypertension, 1.3 \u00b1 0.12; cirrhosis, 1.7 \u00b1 0.2; control, 1.02 \u00b1 0.06; p &lt; 0.05) and partial thromboplastin time ratios (extrahepatic portal hypertension, 1.12 \u00b1 0.1; cirrhosis, 1.26 \u00b1 0.2; controls, 1.01 \u00b1 0.03; p &lt; 0.05) were significantly prolonged in both patient groups. Extrahepatic portal hypertension and cirrhotic patient groups had significantly increased levels of serum total fibrin(ogen)-related antigen (extrahepatic portal hypertension, 818 \u00b1 150 ng\/ml; cirrhosis, 454 \u00b1 52 ng\/ml; controls, 124 \u00b1 7.3 ng\/ml; p &lt; 0.05), fibrin monomer (extrahepatic portal hypertension, 168.8 \u00b1 16.9 ng\/ml; cirrhosis, 115.6 \u00b1 11.1 ng\/ml; controls, 19.7 \u00b1 0.4 ng\/ml; p &lt; 0.05) and D-dimer (extrahepatic portal hypertension, 118 \u00b1 9.6 ng\/ml; cirrhosis, 129 \u00b1 10 ng\/ml; controls, 53.2 \u00b1 1.6 ng\/ml; p &lt; 0.05). Extrahepatic portal hypertension patients had higher total fibrinogen levels (4.15 \u00b1 1.4 gm\/L) than did controls (3.35 \u00b1 0.21 gm\/L; p &lt; 0.05). Patients with extrahepatic portal hypertension (tissue plasminogen activator, 22.1 \u00b1 7; plasminogen activator inhibitor type 1, 51 \u00b1 26) and cirrhosis (tissue plasminogen activator, 23.8 \u00b1 15; plasminogen activator inhibitor type 1, 65 \u00b1 30) had significantly higher concentrations of circulating tissue plasminogen activator and plasminogen activator inhibitor type I than did controls (tissue plasminogen activator, 5.8 \u00b1 1.1 ng\/ml; plasminogen activator inhibitor type 1, 5.2 \u00b1 1.8 ng\/ml; p &lt; 0.05 for both comparisons). Analysis of specific coagulation factors revealed reduced levels of factors V, VII and IX, with increases of factor VIII levels in both patient groups suggestive of compensated mild, disseminated intravascular coagulation. Our data suggest that portal systemic shunting alters parameters of hemostasis, even in the apparent absence of liver disease, and raise the possibility that such shunting is responsible, at least in part, for the disordered coagulation and fibrinolysis seen in patients with chronic liver disease. (HEPATOLOGY 1993;18:853-857).<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.1840180416","type":"journal-article","created":{"date-parts":[[2007,3,4]],"date-time":"2007-03-04T02:07:39Z","timestamp":1172974059000},"page":"853-857","update-policy":"http:\/\/dx.doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":41,"title":["Disordered hemostasis in extrahepatic portal hypertension"],"prefix":"10.1097","volume":"18","author":[{"given":"Simon C.","family":"Robson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delawir","family":"Kahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Kruskal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur R.","family":"Bird","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph E.","family":"Kirsch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"10.1002\/hep.1840180416-BIB1","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1055\/s-2008-1040575","volume":"7","author":"Kelly","year":"1987","journal-title":"Semin Liver Dis"},{"key":"10.1002\/hep.1840180416-BIB2","first-page":"187","volume-title":"Diseases of the liver","author":"Ratnoff","year":"1987","unstructured":"Disordered hemostasis in hepatic disease. In: , eds. Diseases of the liver. 6th ed. Philadelphia: JB Lippincott, 1987: 187\u2013207."},{"key":"10.1002\/hep.1840180416-BIB3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/hep.1840100120","volume":"10","author":"Carr","year":"1989","journal-title":"HEPATOLOGY"},{"key":"10.1002\/hep.1840180416-BIB4","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1055\/s-0028-1087127","volume":"4","author":"Lechner","year":"1977","journal-title":"Semin Thromb Hemost"},{"key":"10.1002\/hep.1840180416-BIB5","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/B978-1-4831-6756-5.50011-6","volume-title":"Progress in liver disease","author":"Deutsche","year":"1965","unstructured":"Blood coagulation changes in liver disease. In: , eds: Progress in liver disease. New York: Grune & Stratton, 1965: 69\u201383."},{"key":"10.1002\/hep.1840180416-BIB6","first-page":"861","volume-title":"Hemostasis and thrombosis: basic principles and clinical practice","author":"Joist","year":"1987","unstructured":"Hemostatic abnormalities in liver disease. In: , , , eds. Hemostasis and thrombosis: basic principles and clinical practice. 2nd ed. Philadelphia: JB Lippincott, 1987: 861\u2013872."},{"key":"10.1002\/hep.1840180416-BIB7","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1172\/JCI115405","volume":"88","author":"Vassalli","year":"1991","journal-title":"J Clin Invest"},{"key":"10.1002\/hep.1840180416-BIB8","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1172\/JCI108773","volume":"60","author":"Palascak","year":"1977","journal-title":"J Clin Invest"},{"key":"10.1002\/hep.1840180416-BIB9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/hep.1840060115","volume":"6","author":"Boks","year":"1986","journal-title":"HEPATOLOGY"},{"key":"10.1002\/hep.1840180416-BIB10","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1056\/NEJM196706152762403","volume":"276","author":"Thomas","year":"1967","journal-title":"N Engl J Med"},{"key":"10.1002\/hep.1840180416-BIB11","first-page":"1","volume-title":"Disseminated intravascular coagulation and related syndromes","author":"Bick","year":"1983","unstructured":"Disseminated intravascular coagulation and related syndromes. Boca Raton, FL: CRC Press, 1983: 1\u201330."},{"key":"10.1002\/hep.1840180416-BIB12","first-page":"280","volume":"60","author":"Pises","year":"1973","journal-title":"Am J Gastroenterol"},{"key":"10.1002\/hep.1840180416-BIB13","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/bjs.1800740720","volume":"74","author":"Kahn","year":"1987","journal-title":"Br J Surg"},{"key":"10.1002\/hep.1840180416-BIB14","unstructured":"Kahn D. A 15-year experience of infetion sclerotherapy in adult patients with extrahepatic portal venous obstruction. Ann Surg, in press."},{"key":"10.1002\/hep.1840180416-BIB15","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/0016-5085(88)90567-7","volume":"94","author":"Valla","year":"1988","journal-title":"Gastroenterology"},{"key":"10.1002\/hep.1840180416-BIB16","doi-asserted-by":"crossref","first-page":"814","DOI":"10.7326\/0003-4819-102-6-814","volume":"102","author":"Schafer","year":"1985","journal-title":"Ann Intern Med"},{"key":"10.1002\/hep.1840180416-BIB17","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1055\/s-2007-1004383","volume":"11","author":"Kitchens","year":"1985","journal-title":"Semin Thromb Hemost"},{"key":"10.1002\/hep.1840180416-BIB18","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1172\/JCI106885","volume":"51","author":"Merskey","year":"1972","journal-title":"J Clin Invest"},{"key":"10.1002\/hep.1840180416-BIB19","first-page":"211","volume":"71","author":"Kruskal","year":"1987","journal-title":"S Afr Med J"},{"key":"10.1002\/hep.1840180416-BIB20","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1159\/000205234","volume":"17","author":"Clauss","year":"1957","journal-title":"Acta Haematol"},{"key":"10.1002\/hep.1840180416-BIB21","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1056\/NEJM198711263172201","volume":"317","author":"Kruskal","year":"1987","journal-title":"N Engl J Med"},{"key":"10.1002\/hep.1840180416-BIB22","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1002\/hep.1840160411","volume":"16","author":"Kruskal","year":"1992","journal-title":"HEPATOLOGY"},{"key":"10.1002\/hep.1840180416-BIB23","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1146\/annurev.me.24.020173.002003","volume":"24","author":"Kwaan","year":"1973","journal-title":"Annu Rev Med"},{"key":"10.1002\/hep.1840180416-BIB24","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/j.1600-0609.1966.tb02378.x","volume":"3","author":"Godal","year":"1966","journal-title":"Scand J Haematol"},{"key":"10.1002\/hep.1840180416-BIB25","first-page":"215","volume":"7","author":"Hardisty","year":"1962","journal-title":"Thromb Diathesis Haemorrhagica"},{"key":"10.1002\/hep.1840180416-BIB26","first-page":"48","volume-title":"Blood coagulation and haemostasis: a practical guide","author":"Giddings","year":"1980","unstructured":"The investigation of hereditary coagulation disorders. In: ed. Blood coagulation and haemostasis: a practical guide. Edinburgh: Churchill Livingstone, 1980: 48\u2013116."},{"key":"10.1002\/hep.1840180416-BIB27","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0003-2697(66)90246-6","volume":"15","author":"Laurell","year":"1966","journal-title":"Anal Biochem"},{"key":"10.1002\/hep.1840180416-BIB28","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1055\/s-0038-1661109","volume":"51","author":"Verheijen","year":"1984","journal-title":"Thromb Hemost"},{"key":"10.1002\/hep.1840180416-BIB29","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/00007890-199209000-00010","volume":"54","author":"De Jager","year":"1992","journal-title":"Transplantation"},{"key":"10.1002\/hep.1840180416-BIB30","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1055\/s-0038-1650106","volume":"44","author":"Ardaillou","year":"1980","journal-title":"Thromb Hemost"},{"key":"10.1002\/hep.1840180416-BIB31","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1111\/j.1365-2141.1976.tb03589.x","volume":"34","author":"Green","year":"1976","journal-title":"Br J Haematol"},{"key":"10.1002\/hep.1840180416-BIB32","doi-asserted-by":"crossref","first-page":"5210","DOI":"10.1016\/S0021-9258(19)44958-2","volume":"247","author":"Mosesson","year":"1972","journal-title":"J Biol Chem"},{"key":"10.1002\/hep.1840180416-BIB33","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1056\/NEJM199203193261205","volume":"326","author":"Furie","year":"1992","journal-title":"N Engl J Med"},{"key":"10.1002\/hep.1840180416-BIB34","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1172\/JCI105990","volume":"48","author":"Rothschild","year":"1969","journal-title":"J Clin Invest"},{"key":"10.1002\/hep.1840180416-BIB35","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1055\/s-0028-1091330","volume":"1","author":"Reeve","year":"1974","journal-title":"Semin Thromb Hemost"},{"key":"10.1002\/hep.1840180416-BIB36","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1152\/ajplegacy.1968.214.2.414","volume":"214","author":"Deykin","year":"1968","journal-title":"Am J Physiol"},{"key":"10.1002\/hep.1840180416-BIB37","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1172\/JCI104953","volume":"43","author":"Fletcher","year":"1964","journal-title":"J Clin Invest"},{"key":"10.1002\/hep.1840180416-BIB38","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/0168-8278(91)90928-5","volume":"12","author":"Triger","year":"1991","journal-title":"J Hepatol"},{"key":"10.1002\/hep.1840180416-BIB39","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1172\/JCI110945","volume":"71","author":"Colucci","year":"1983","journal-title":"J Clin Invest"},{"key":"10.1002\/hep.1840180416-BIB40","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1182\/blood.V73.3.729.729","volume":"73","author":"Clozel","year":"1989","journal-title":"Blood"},{"key":"10.1002\/hep.1840180416-BIB41","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1056\/NEJM198905043201802","volume":"320","author":"Suffredini","year":"1989","journal-title":"N Engl J Med"},{"year":"1989","author":"Arai","key":"10.1002\/hep.1840180416-BIB42","unstructured":", , , , , , et al. Endotoxin-induced hypercoagulability: a possible aggravating factor of alcoholic liver disease. 1989; 9: 846\u2013851."}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhep.1840180416","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01515467-199310000-00015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T11:07:38Z","timestamp":1733051258000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01515467-199310000-00015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,10]]},"references-count":42,"journal-issue":{"issue":"4","published-print":{"date-parts":[[1993]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.1840180416","relation":{},"ISSN":["0270-9139"],"issn-type":[{"type":"print","value":"0270-9139"}],"subject":[],"published":{"date-parts":[[1993,10]]}}}