Hyperfibrinolytic activity in hospitalized cirrhotic patients in a referral liver unit

OBJECTIVE: Increased frequency of hyperfibrinolytic activity was reported i n patients with cirrhosis. However, the incidence, clinical presentation, a nd the parameters related to hyperfibrinolysis remain largely unknown in th ese patients. By utilizing euglobulin lysis time (ELT) and other clinical c oagulation tests, the present study investigated the incidence of and clini cal parameters related to hyperfibrinolytic activity, and assessed predicti ng factors to E-aminocaproic acid (EACA) treatment in cirrhotic patients wi th hyperfibrinolysis in a liver unit. METHODS: The study included 86 consecutive patients who were referred and a dmitted to a referral liver unit for various liver diseases. The mean age w as 50.0 yr, with a male: female ratio of 60:26. Sixty-six patients (76.7%) were Hispanic and 75 (87.2%) were cirrhotic. The etiologies of liver diseas es included alcoholic liver disease (n = 68, 79.1%), hepatitis B (n = 2, 2. 3%), hepatitis C (n = 6, 7.0%), autoimmune hepatitis (n = 3, 3.5%), cryptog enic liver disease (n = 4, 4.7%), and hepatocellular carcinoma (n = 3, 3.5% ). Coagulation studies included ELT, PT, PTT, fibrinogen, D-dimer, and fibr in degradation product levels. RESULTS: Hyperfibrinolytic activity as reflected by shortened ELT was prese nt in 27/75 cirrhotic (31.3%) but 0/11 noncirrhotic patients, which was sig nificantly correlated with higher Child-Pugh (C-P) class, abnormal levels o f PT, PTT, fibrinogen, platelet count, and total bilirubin. Shortened ELT w as more frequently seen in patients with hepatic decompensation and mucocut aneous bleeding, although these relationships were not statistically signif icant. In 27 patients with hyperfibrinolysis, five (18.5%) required EACA tr eatment for progressive mucocutaneous bleeding and/or hematoma. EACA treatm ent was significantly associated with higher C-P scores; greatly shortened ELT (less than or equal to 50% of normal value); and abnormal levels of fib rinogen, total bilirubin, and PT, indicating that these factors may serve a s predictors for EACA treatment. CONCLUSION: Hyperfibrinolytic activity was seen in 31.3% of patients with c irrhosis, which is correlated with higher C-P scores; abnormal PT, PTT, fib rinogen level, and platelet count; and hyperbilirubinemia. Patients who rec eived EACA treatment usually have a more severe hyperfibrinolytic activity as indicated by shortened ELT and low level of fibrinogen, and more severe liver disease as indicated by higher C-P scores and hyperbilirubinemia. (C) 2001 by Am. Cell. of Gastroenterology.