Global Advanced Research Journal of Medicine and Medical Sciences (GARJMMS) ISSN: 2315-5159
November 2017 Vol. 6(11), pp. 302-309
Copyright © 2017 Global Advanced Research Journals


Full Length Research Paper

Significance of von Willebrand Factor in Compensated and Decompensated Cirrhosis

Mohsen M. Maher1*, Tarek M. Yosef1, Wesam A. Ibrahim1, Maha M. Hussein1, Manal Mohsen2, Ahmed S. Khayal1, Walaa Hashem1, Manal Ghozlan2 and Emad Abd-Eldayem3.

1Internal Medicine Department, Ain Shams University.
2Clinical Pathology Department, Ain Shams University.
3Radiology Department, Ain Shams University.

*Corresponding Author E-mail:,;                 Phones: +0201001815402, +0201159469494

Accepted 22 November, 2017


Liver cirrhosis is associated with extensive alternations in hemostatic functions. Among these alternations, von Willebrand factor (vWF) is found to be elevated. However, its clinical significance is not well established. To demonstrate the relation between vWF level and platelet function and its relation to portal hypertension in patients with liver cirrhosis of different severity. 70 patients with liver cirrhosis were compared to 20 healthy control subjects. For all participants; vWF antigen (Ag) was measured by enzyme-linked immunosorbent assay. von Willebrand factor: ristocetin cofactor activity (vWF:RCo) –a measure of ability of vWF to interact with platelet glycoprotein Ib-was measured by agglutination technique. Ratio between vWF: RCo to VWF Ag which reflects the functional capacity of vWF was calculated (RCo/Ag ratio). Portal hypertension (PH) was assessed in patients group by portal vein duplex, congestion index and esophagogastroduodenoscopy (EGD). vWF Ag and vWF:RCo are significantly increased in patients group compared to control (31.6µg/ml and 94.5% compared to 9.4µg/ml and 65.3% respectively) while RCo/Ag ratio is significantly lower in patients group compared to control (4.2 and 8.6 respectively) indicating a reduction in the functional capacity of vWF. There is a significant positive correlation between vWF Ag and Child Pugh score of the patients and a strong positive correlation between vWF Ag and severity of PH. vWF level at cut off value 14.85µg/ml can predict PH with 98.1% sensitivity and 88.9% specificity. vWF Ag and vWF: RCo are increased in patients with liver cirrhosis. Their increase is positively correlated with severity of liver cirrhosis and partially compensate for reduced platelet count. vWF Ag is sensitive and non-invasive predictor of PH.

Keywards: vWF, ristocetin, liver Cirrhosis, portal hypertension.



Al-Nakshabandi NA (2006). The role of ultrasonography in portal hypertension. The Saudi J. Gastroenterol. 12(3):111-117.

Ferlitsch M, Reiberger T, Hoke M, et al (2012). Von Willebrand Factor as new non-invasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis. Hepatology.

Ghweil AA, Arafa UA, Khodeary A, et al (2014). Predictors of bleeding from esophageal varices: The role of factor VII and von willebrand factor. Open J. Gastroenterol. 4:152-158.

Kamath PS, Kim WR (2007). The Model for End-Stage Liver Disease (MELD). Hepatol. 45(3): 797-805.

La Mura V, Reverter JC, Arroyo AF, et al (2011). Von Willebrand factor levels predict clinical outcome in patients with cirrhosis and portal hypertension. Gut. 60:1133-1138.

Lisman T, Bongers TN, Adelmeijer J, et al (2006). Elevated levels of von willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatol. 44(1):53-61.

Lisman T, Leebeek FWG (2007). Hemostatic Alterations in Liver Disease: A Review on Pathophysiology, Clinical Consequences, and Treatment. Digestive Surgery. 24:250-258.

Potze W, Porte RJ, Lisman T (2015). Management of coagulation abnormalities in liver disease. Expert Rev. Gastroenetrol. Hepatopl. 9(1):103-114.

Pugh RN, Murray-Lyon IM, Dawson JL, et al (1973). Transection of the oesophagus for bleeding oesophageal varices.The Br. J. Surg. 60(8):646-649.

Ruggeri ZM (1997). Von Willebrand Factor. J. Clin. Invest. 99 (4):559-564.

Ruggeri ZM (2003).  Von Willebrand factor, platelets and endothelial cell interactions. J. Thrombosis and Haemostasis. 1:1335-1342.

Tripodi A, Mannucci PM (2007). Abnormalities of hemostasis in chronic liver disease: Reappraisal of their clinical significance and need for clinical and laboratory research. J. Hepatol. 46:727-733.

Tripodi A, Mannucci PM (2011). The coagulopathy of chronic liver disease. The New England Journal of Medicine, 365:147-156.

Vizzutti F, Arena U, Rega L, et al (2008). Non invasive diagnosis of portal hypertension in cirrhotic patients. Gastroentérologie Clinique et Biologique. 32:80-87.

Yilmaz VT, Dincer D, Avci AB, et al (2015). Significant association between serum levels of Von Willebrand Factor antigen with stages of cirrhosis. The Eur. J. Med. 47:21-25.

Zheng XL (2015). ADAMTS13 and von Willebrand Factor in thrombotic thrombocytopenic purpra. The Annual Rev. Med. 66:211-225.

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Mohsen M Maher on Google Scholar
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Tarek M Yosef on Google Scholar
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