THE HYPERFIBRINOLYTIC STATE OF LIVER-CIRRHOSIS - POSSIBLE PATHOGENETIC ROLE OF ASCITES

We evaluated coagulation and fibrinolytic parameters in both plasma an d ascitic fluid of 39 patients with ascites secondary to liver cirrhos is and in 14 cirrhotic patients without ascites, in order to verify if the peritoneal compartment could be involved in the pathogenesis of t he hyperfibrinolytic state of the disease. An activation of fibrinolys is, as suggested by increased levels of FDP, D-dimer and tissue plasmi nogen activator (t-PA) was demonstrated in both ascitic fluid and to a lesser extent in plasma. A positive correlation was also observed bet ween plasma and ascitic fluid plasminogen, antiplasmin and fibrinogen, while a negative correlation was found between plasma and ascitic flu id plasminogen activator inhibitor-1 (PAI-1). Moreover, plasma PAI-1 w as significantly lower in patients with ascites than in those without ascites and among ascitic patients in those who had bleeding into soft tissues when compared to those who did not present haemorrhagic event s. Finally, a significant association was also shown between positivit y for plasma D-dimer (> 200 ng/ml) and the presence of ascites. Taken together, our data suggest an exchange of some coagulation and fibrino lytic proteins between plasma and ascitic fluid and point out the key role of PAI-1 in regulating plasma fibrinolytic potential and in bleed ing complications in cirrhotic patients.