INTRAVASCULAR CLOTTING ACTIVATION AND SYSTEMIC HYPERFIBRINOLYSIS IN PATIENTS WITH SEVERE LIVER-CIRRHOSIS - THE ROLE OF ASCITES

The objective of this study was to investigate whether ascites favours the occurrence of systemic hyperfibrinolysis in liver cirrhosis (LC) patients. We studied coagulation and fibrinolytic systems in 10 LC pat ients with ascites and 10 without ascites, matched for age, sex and de gree of liver failure. In patients with ascites blood coagulation and fibrinolytic studies were performed also after ascites remission. LC p atients had significantly higher plasma values of human prothrombin fr agment F 1+2, a marker of thrombin generation (p=0.0001), lower plasma fibrinogen (p<0.02) and prothrombin activity (p=0.001) than normal co ntrols. Higher plasma levels of tissue plasminogen activator (t-PA) an tigen (p<0.01), F 1+2 (p=0.03) and D-dimer (p=0.02) were detected in a scitic patients compared to non ascitic ones. All patients with ascite s had F 1+2>1nM (mean+2 SD of controls) and high values of plasma D-di mer. After ascites remission, a significant increase of plasma fibrino gen (p<0.02) and a significant decrease of plasma D-dimer (p<0.01), F 1+2 (p<0.02) and t-PA antigen (p<0.02) were found; liver failure score d by Child-Pugh's criteria and prothrombin activity did not change sig nificantly. This study shows that ascitic patients have a hyperfibrino lytic condition secondary to intravascular clotting activation. The re duction of hyperfibrinolysis by ascites remission suggests that ascite s favours the occurrence of this coagulopathy but the mechanism needs to be further investigated.