Ascites fluid as a possible origin for hyperfibrinolysis in advanced liverdisease

OBJECTIVES: Advanced liver disease is associated with both exaggerated fibr inolysis and with ascites. This study was undertaken to determine whether f ibrinolytic activity exists in the ascites fluid of patients with liver dis ease and to see whether such activity is associated with evidence of plasma fibrinolysis. METHODS: Both the ascites fluid and plasma from 15 patients' with cirrhotic ascites (group A) were evaluated for markers of fibrinolysis: fragment D-d imer, plasminogen, fibrinogen, and fibrin split products. In addition, the euglobulin lysis time, a test highly specific for fibrinolysis, was evaluat ed in the ascites fluid samples. As a control group, the plasma from 15 cir rhotic patients without ascites (group B) was evaluated for markers of fibr inolysis. RESULTS: In group A, elevated fragment D-dimer and fibrin split products we re uniformly found in ascites fluid in concentrations that would be conside red pathologically elevated if in plasma. Ascites fluid was also depleted, compared with plasma,:of both plasminogen and fibrinogen. These results, al ong with the short euglobulin lysis time in 83% of the patients,;suggest th at increased fibrinolytic activity is present in ascites fluid. In 93% of t hese patients, plasma D-dimer was elevated. The mean plasma plasminogen was also low in these patients. In group B, only 33% of patients had elevated plasma D-dimer. CONCLUSIONS: Ascites fluid has fibrinolytic activity. Because ascites fluid reenters the systemic circulation via the thoracic duct, via a natural per itoneovenous shunt, ascites fluid warrants serious consideration as a patho logical fluid that contributes to the systemic fibrinolytic state found in the majority:of our patients with ascites. (C) 2000 by Am. Cell. of Gastroe nterology.