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Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests
Author(s) -
RIJKEN D. C.,
KOCK E. L.,
GUIMARÃES A. H. C.,
TALENS S.,
MURAD S. DARWISH,
JANSSEN H. L. A.,
LEEBEEK F. W. G.
Publication year - 2012
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2012.04901.x
Subject(s) - hyperfibrinolysis , fibrinolysis , medicine , cirrhosis , gastroenterology , concomitant
Summary. Background and objectives: It has been known for a long time that cirrhosis is associated with hyperfibrinolysis, which might contribute to an increased risk and severity of bleeding. However, recent papers have questioned the presence of a hyperfibrinolytic state in cirrhotic patients and postulated a rebalanced system owing to concomitant changes in both pro‐ and anti‐fibrinolytic factors. Therefore we re‐investigated the fibrinolytic state of cirrhotic patients using two different overall tests including a recently developed test for global fibrinolytic capacity (GFC) using whole blood. Patients and methods: Blood was collected from 30 healthy controls and 75 patients with cirrhosis of varying severity (34 Child–Pugh A, 28 Child–Pugh B and 13 Child–Pugh C). The plasma clot lysis time (CLT), which is inversely correlated with fibrinolysis, was determined as well as the GFC. Results: The mean CLT was 74.5 min in the controls and decreased significantly to 66.9 min in Child–Pugh class A patients, 59.3 min in class B patients and 61.0 min in class C patients, and hyperfibrinolysis existed in 40% of the patients. The median GFC was 1.7 μg mL −1 in the controls and increased significantly to 4.0 μg mL −1 in Child–Pugh class A patients, 11.1 μg mL −1 in class B patients and 22.5 μg mL −1 in class C patients, and hyperfibrinolysis existed in 43% of the patients. Taken together, 60% of the patients showed hyperfibrinolysis in at least one of the two global assays. Conclusion: A rebalanced fibrinolytic system may occur, but hyperfibrinolysis is found in the majority of patients with cirrhosis.