Hemostasis activation in patients with liver cirrhosis

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

“…Thus, the results of this study add further support to the concept, based on a large amount of published evidence, that AICF is not a common feature in patients with nonadvanced, stable liver cirrhosis without complications. However, because relatively few patients with end stage cirrhosis were enrolled and patients with complications such as recent esophageal or gastric bleeding and coexisting conditions such as shock, infection, recent surgery, trauma, and malignancy were excluded, the results of the study by Ben Ari et al (22) do not refute extensive, previously published evidence (12)(13)(14)(15)(16)(17)(18)(19)(20) that such patients may be prone to develop AICF and DIC as manifestations of a systemic hypercoagulable state with, perhaps, preferential expression in the portal circulation (23). This concept is supported by the findings that large vessel thrombosis, particularly portal vein thrombosis, may occur in 15% of patients with cirrhosis (24) and microvascular thrombosis in one or multiple organs was observed in 50% and 2%, respectively in one anatomic/pathologic study of 184 cases with liver disease (25).…”

“…Will use of special tests for AICF employed in this study (such as F1.2, TAT, ATIII, and D-dimer), which are currently not available in most clinical laboratories or not routinely used, be helpful in the management of patients with liver cirrhosis? The finding that the extent of AICF may be inversely related to the level of ATIII (18,20) and that shortened fibrinogen survival could be prolonged (11) and fibrinogen increased (27) with administration of ATIII might indicate a possible beneficial effect of ATIII in patients with very low levels of ATIII and, thus, usefulness of monitoring of ATIII. Whether selected patients with evidence of AICF may benefit from heparin therapy, perhaps in low doses and combined with ATIII, as has been suggested by observational studies (28,29), remains to be determined by controlled studies.…”

“…With the use of these tests, it has been possible to detect accelerated intravascular coagulation and fibrinolysis (AICF) more definitively in patients with liver cirrhosis (12)(13)(14)(15)(16)(17)(18)(19)(20). Unfortunately, in most of these studies, the terms DIC or low grade DIC are used frequently for AICF, which is confusing.…”

Kronik karaciğer hastalığı olan çocukluklarda doğal antikoagülan düzeyleri

“…Özellikle sirozlu hastalarda tromboz riskinin artmas›na ba¤l› olarak portal ven trombozu (PVT) etiolojisinde do¤al antikoagülan düzeylerinde düflüklü¤ün rol oynayabilece¤i bildirilmifltir (4)(5)(6)(7)(8).…”

“…Çocuklarda veri olmamakla birlikte do¤al antikoagülan-lar olan PC, PS ve AT'nin kronik karaci¤er hastal›¤› olan eriflkinlerde de¤iflik derecelerde azald›¤› baz› çal›flmalarda gösterilmifltir (4)(5)(6)(7)(8). Özellikle sirozlu olgularda PC, PS ve AT'nin önemli derecede azald›¤› ve hemostaz aktivasyon göstergelerinden biri olan D-Dimer ile aralar›nda negatif bir iliflki oldu¤u, hemostaz aktivasyonu ile antikoagülan potansiyeli aras›ndaki iliflkinin varl›¤› gösterilmifltir (4).…”