Decreased antithrombin III: is it a cause or a result of oesophageal varices bleeding in endemic hepatic schistosomiasis

Chronic liver disease is often associated with many hemostatic abnormalities including decreased level of antithrombin 3 [AT3]. However, the involvement of AT3, in esophageal varices bleeding has not been demonstrated before. The aim of this study is to demonstrate the hemostatic abnormalities especially the disturbance in AT3 level in patients with bleeding esophageal varices. Forty subjects were studied including 10 normal control cases, 15 cases with bleeding esophageal varices [group 1] and 15 cases with silent varices [group 2]. All cases were subjected to the following hemostatic tests: Prothrombin time [PT], partial thromboplastin time [PTT], antithrombin 3 level, fibrinogen [F] and fibrin degradation products [FDP]. All these tests were done to patients of group 1, the first during the bleeding episode [la] and the second after control of bleeding by two weeks [lb]. There was significant deterioration in all the hemostatic parameters studied in both groups 1 and 2 compared to control. Further significant impairment in some of these parameters namely PT, AT3, FDP and platelet count occurred in patients of group 1 during active bleeding [la] compared to silent varices patients [group 2]. Most of these test differences disappeared after control of bleeding by two weeks with the exception of AT3, which was still significantly lower in group 1b compared with group 2 [p <0.005]. It was concluded that AT3 might be of great value to predict hepatic patients prone to bleed through their esophageal varices. Further prospective studies are needed