ASSOCIATION BETWEEN HIGH VALUES OF D-DIMER AND TISSUE-PLASMINOGEN ACTIVATOR ACTIVITY AND FIRST GASTROINTESTINAL-BLEEDING IN CIRRHOTIC-PATIENTS

Cirrhotic patients with decompensated state and high serum levels of f ibrin(ogen) degradation products are at high risk of bleeding. The aim of this study was to further analyse the relationship between hyperfi brinolysis and bleeding in cirrhosis by measuring plasma values of D-d imer and tissue plasminogen activator (t-PA) activity. One-hundred-twe lve cirrhotic patients with oesophageal varices and without previous u pper-gastrointestinal bleeding entered the study and were followed-up for 3 years. Patients were considered to have hyperfibrinolysis if the y concomitantly had high values of D-dimer and t-PA activity. During t he follow-up 34 (30%) patients bled. They had more severe liver failur e (p=0.0001) and variceal size (p=0.0031) and higher prevalence of asc ites (p=0.0003), varices with red signs and hyperfibrinolysis (p=0.000 1) than patients who did not bleed. Multivariate analysis disclosed hy perfibrinolysis as the only marker predictive of bleeding (Hazard Rati o=42.5, p <0.001). Our findings suggest that screening for hyperfibrin olysis may be useful to identify cirrhotic patients at risk of-bleedin g.