The hyperfibrinolytic state of liver cirrhosis: possible pathogenetic role of ascites

Toschi, Vincenzo; Rocchini, G. M.; Motta, A.; Fiorini, Gianfrancesco; Cimminiello, Claudio; Violi, Francesco; Castelli, Christel; Sironi, D.; Gibelli, A

doi:10.1016/0753-3322(93)90084-x

Cited by 22 publications

(17 citation statements)

References 28 publications

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“…However, our study showed that no significant correlation was observed for the other two major components, factor t-PA and PAI-1 in fibrinolytic system, with the Child-Pugh scores and PVT. It was noticed that, in contrast to some published data, [22][23][24] the levels of t-PA and PAI-1 did not significantly correlate with the Child-Pugh score in our study, which was in accordance with another report. 25 Although our data indicated the significantly decreased t-PA level in Child-Pugh class B of the PVT group compared with the control group, we failed to demonstrate a similar difference in the other two groups, which probably suggests the necessity of increased cases in interpreting the role of t-PA in PVT formation.…”

Section: Discussionsupporting

confidence: 85%

Protein C and D‐dimer are related to portal vein thrombosis in patients with liver cirrhosis

Zhang

Hao

Yang

2009

J of Gastro and Hepatol

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Section: Discussionsupporting

confidence: 85%

Protein C and D‐dimer are related to portal vein thrombosis in patients with liver cirrhosis

Zhang

Hao

Yang

2009

J of Gastro and Hepatol

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“…The data suggest that hyperfibrinolysis is common even in less advanced cirrhosis. Although prior investigations indicated that ascites might be the source of hyperfibrinolysis in plasma [14,15], our study could not demonstrate the association of laboratory fibrinolysis, and the physical signs of ascites. There is also no association between hyperfibrinolysis and the etiologies of cirrhosis (data not shown).…”

Section: Discussioncontrasting

confidence: 45%

Hyperfibrinolysis and the risk of hemorrhage in stable cirrhotic patients

et al. 2010

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Background:Bleeding is an important complication of cirrhosis. Currently, there is no coagulation test that can reliably predict clinical hemorrhage. However, previous studies demonstrated significant correlations between hyperfibrinolysis and following bleeding in advanced cirrhotic patients. Objectives: Estimate the prevalence of hyperfibrinolysis in cirrhotic patients at stable conditions and to assess its role in predicting subsequent hemorrhage. Methods: The prospective cohort study included 58 consecutive cirrhotic patients at the Liver Clinic, Chulalongkorn Hospital. Assays for liver functions, PT, APTT, fibrinogen, fibrin degradation products (FDPs) and euglobulin lysis time (ELT) were performed at baseline. The subjects were followed-up for 10 months to observe clinical hemorrhage and survival. Results: The mean age was 56.4 years and 47% were male. The etiologies of liver diseases were virus (62.1%), alcohol (24.1%) or unknown (8.6%). Hyperfibrinolysis as reflected by ELT<120 minutes or FDPs>10 μg/mL was present in 32.8% and 74.1%, respectively. Fibrinolytic activity was significantly correlated with platelet counts and coagulation times, but not as much with liver function tests. By 10 months, 13 cases (22.4%) showed hemorrhagic episodes and 7 (12.1%) were expired, including 2 from bleeding. The significant predictors for death were Child class B or C, presence of ascites, hyperbilirubinemia, hypoalbuminemia, and prolonged APTT. However, none of the clinical, biochemical, or hemostatic factors was associated with clinical bleeding. Conclusion: Hyperfibrinolysis is common in cirrhotic outpatients. However, it cannot predict subsequent hemorrhage or survival. Novel hemostatic tests are required to assess the probability of bleeding in this disorder.

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“…Most interestingly, TAT cut‐offs at 5.35 and 14.6 ng/mL clearly disclosed two patient populations with a highly different probability of development of new‐onset ascites and VB, respectively. Other investigators have also shown that patients with cirrhosis and ascites or VB display markedly higher levels of TAT and DD than those without suggesting that activation of hemostasis could be implicated in the development of these complications.…”

Section: Discussionmentioning

confidence: 96%

Thrombin generation measured as thrombin–antithrombin complexes predicts clinical outcomes in patients with cirrhosis

Kalambokis¹,

Oikonomou²,

Baltayiannis

et al. 2015

Hepatology Research

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Aim: Hypercoagulability has been detected in patients with cirrhosis yet its clinical significance remains unclear. We investigated the association of hypercoagulability with clinical outcomes in patients with cirrhosis. Results: Eighty-one patients (Child-Pugh class A/B/C: 27/27/27) and 40 healthy subjects were enrolled. Only and AT were independently associated with increasing liver disease severity. Increased TAT levels and MELD score were significantly associated with ascites and varices at baseline. Independent predictors of follow-up events were: TAT and MELD score for new-onset ascites; TAT and AT for variceal bleeding (VB); TAT and AT for portal vein thrombosis (PVT); and TAT and MELD for mortality. TAT equaled MELD in mortality prediction at 12 and 18 months. TAT cut-offs at 5.35, 14.6, 13.5 and 9.25 ng/mL identified patient groups with significantly higher probability of new-onset ascites, VB, PVT and mortality, respectively. Methods: Conclusion:Increased TG is strongly correlated with portal hypertension-related complications, PVT and mortality in patients with cirrhosis. Measuring TG by TAT could enable risk stratification and institution of preventive strategies to improve clinical outcomes.

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The hyperfibrinolytic state of liver cirrhosis: possible pathogenetic role of ascites

Cited by 22 publications

References 28 publications

Protein C and D‐dimer are related to portal vein thrombosis in patients with liver cirrhosis

Protein C and D‐dimer are related to portal vein thrombosis in patients with liver cirrhosis

Hyperfibrinolysis and the risk of hemorrhage in stable cirrhotic patients

Thrombin generation measured as thrombin–antithrombin complexes predicts clinical outcomes in patients with cirrhosis

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