The Significance of Ascites as a Cause of Systemic Hyperfibrinolysis in Liver Cirrhosis

Kim, Si Young; Kim, Byung Ik; Cho, Yong Kyun; Suh, Jung Yul; Kim, Chang Seop; Park, Chang Young; Sohn, Chong Il; Jeon, Woo Kyu

Abstract

BACKGROUND/AIMS: The patients with liver cirrhosis (LC) have a bleeding tendency, but sometimes its cause is not clarified by routine coagulation studies such as prothrombin time. In patients with LC, increased fibrinolysis may contribute to their susceptibility to serious bleeding events such as variceal hemorrhage. This study was undertaken to see whether ascites has fibrinolytic activity and to determine whether cirrhotic patients with ascites are more likely to have increased plasma fibrinolysis than cirrhotic patients without ascites.
METHODS
The subjects consisted of 34 patients with LC from May 2001 to November 2001. We divided the subjects into two groups. One was the group of LC patients with ascites (group A, n=15) and the other was the group of LC patients without ascites (group B, n=19). We evaluated the markers of fibrinolysis from both ascites and plasma in group A, and from plasma in group B.
RESULTS
Group A has increased plasma fibrinolytic activity than group B (p<0.05). In group A, elevated fragment D-dimer and FDP and also depleted both plasminogen and fibrinogen were observed in ascites compared with reference value of plasma. The mean plasma to ascites plasminogen concentration ratio was 9.3+/-5.8. These results suggest that increased fibrinolytic activity is present in cirrhotic ascites.
CONCLUSIONS
The fibrinolytic activity in ascites of LC patients may contribute to the systemic hyperfibrinolysis and bleeding complication. Thus, to prevent bleeding of patients with LC, more intensive control of ascites may be needed.