AICF and DIC in Liver Cirrhosis: Expressions of a Hypercoagulable State

Hematological Issues in Liver Disease

“…30 The fibrinogen count is typically less than 120 mg/dL in patients with AICF and it is clinically seen as oozing from puncture sites or indwelling catheter sites. Adding further confusion to states of low fibrinogen, patients with liver disease can develop overt DIC or an overlap of AICF and DIC.…”

“…Adding further confusion to states of low fibrinogen, patients with liver disease can develop overt DIC or an overlap of AICF and DIC. 30 Although FVIII levels are elevated in AICF and decreased in DIC, the differentiation between these 2 syndromes is difficult to determine and there is not a gold standard test available to date.…”

Coagulation disorders and hemostasis in liver disease

“…However, to account for the unusual features of both hyperfibrinolysis and DIC that are often evident in the decompensated liver disease patient, the term "accelerated intravascular coagulation and fibrinolysis" (AICF) has been proposed as a way to encapsulate the process under a single heading. 26 The essence of AICF can be postulated to be the result of formation of a fibrin clot that is more susceptible to plasmin degradation due to elevated levels of tPA coupled with inadequate release of PAI to control tPA and lack of ␣-2 plasmin inhibitor to quench plasmin activity and the maintenance of high local concentrations of plasminogen on clot surfaces despite lower total plasminogen production. These normally balanced processes become pronounced when further disturbed by additional stress such as infection.…”

Coagulopathy in liver disease: Lack of an assessment tool

“…These methodological differences explain why studies assessing fibrinolysis have led to controversial findings [46,47] . Hyperfibrinolysis markers have been found in 30% of cirrhotic patients and are proportional to the degree of hepatic dysfunction, pointing to activation of clotting (mediated by the FVIII/protein C imbalance), with secondary hyperfibrinolysis [48][49][50] . These coagulation disturbances resemble disseminated intravascular coagulation; a relatively stable platelet count and characteristically high FVIII levels distinguish this process from disseminated intravascular coagulation.…”