Ascites fluid as a possible origin for hyperfibrinolysis in advanced liver disease

Abstract

Ascites fluid has fibrinolytic activity. Because ascites fluid reenters the systemic circulation via the thoracic duct, via a natural peritoneovenous shunt, ascites fluid warrants serious consideration as a pathological fluid that contributes to the systemic fibrinolytic state found in the majority of our patients with ascites.

High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis

“…High D-dimer levels in 64% of patients with liver cirrhosis were observed. This finding is in agreement with that of Agarwal et al who reported increased plasma D-dimers in 63% of patients with liver cirrhosis [1] . This percentage is higher than that reported in another study where abnormal D-dimers were found only in 17% of patients with chronic liver disease.…”

“…When we divided our patients into two groups, according to the presence of ascites, we found high D-dimers in 81% of patients with ascites and in 39% of patients without. This finding is also consistent with that of Agarwal et al who showed increased plasma D-dimer values in 93% and 33% of patients with and without ascites, respectively [1] . Furthermore, our patients with ascites had mean D-dimer values significantly higher than those without.…”

“…The pathogenesis of hyperfibrinolysis in liver cirrhosis is not yet clearly known. Having found high D-dimer levels in the blood and in the ascitic fluid, Agarwal et al suggested ascites among the possible causes of increased fibrinolysis in patients with liver cirrhosis [1] . The aim of our study was (1) to evaluate the relationship between the presence of ascites and hyperfibrinolytic state in cirrhotic patients measuring the circulating levels of D-dimer in those with and without ascites and (2) to assess the effect of ascites resolution in the concentration of D-dimers.…”

“…Some authors suggest the exchange of some coagulation and fibrinolytic proteins between plasma and ascitic fluid [1,11] . Violi et al propose that hyperfibrinolysis in cirrhotic patients might represent a state of low grade disseminated intravascular coagulation secondary to the passage of gut absorbed bacterial material into the systemic circulation [12] .…”

“…Plasma levels of fragment D-dimer represent an accurate marker of fibrinolytic activity. The finding of high D-dimer plasma concentration in patients with liver cirrhosis, decompensated by ascites, led Agarwal et al [1] to suggest a major role of ascites in the pathogenesis of hyperfibrinolytic state associated with liver failure. The aims of this study were: (1) to evaluate the relationship between the presence of ascites and hyperfibrinolytic state in liver cirrhosis measuring the circulating levels of D-dimer in patients with and without ascites and (2) to assess the effect of ascites resolution in the plasma concentration of D-dimers.…”