Coagulopathy during ascites reinfusion: prevention by antiplatelet therapy

Area of Science:

• Gastroenterology
• Hematology
• Pathophysiology

Background:

• Cirrhosis patients with refractory ascites often undergo procedures involving ascitic fluid.
• Disseminated intravascular coagulation (DIC) is a serious complication that can arise in various clinical settings.

Purpose of the Study:

• To investigate the development of DIC during controlled intravenous infusion of concentrated ascitic fluid in patients with cirrhosis.
• To determine the role of ascitic fluid collagen in the pathogenesis of DIC.

Main Methods:

• Nine studies were conducted on patients with cirrhosis and refractory ascites who did not receive prophylactic antiplatelet therapy.
• Laboratory evidence of DIC was assessed, and collagen infusion was estimated by ascitic hydroxyproline concentration.
• Coagulation profiles were monitored during and after ascitic fluid infusion, and the effect of antiplatelet therapy (aspirin and dipyridamole) was evaluated.

Main Results:

• All nine patients developed laboratory evidence of DIC following ascitic fluid infusion.
• A significant correlation was found between the amount of collagen infused and the prolongation of partial thromboplastin time with kaolin (r = 0.8628; P < 0.005) and the decrease in platelet count (r = 0.5674; P < 0.05).
• Coagulation changes were reversible within 12 hours of ceasing infusion, and no DIC was observed in patients receiving antiplatelet therapy.

Conclusions:

• Intravenous infusion of concentrated ascitic fluid in cirrhosis patients induces DIC.
• The severity of DIC correlates with the quantity of collagen infused.
• Inhibiting collagen-induced platelet aggregation completely prevents DIC, supporting the role of ascitic fluid collagen in this complication.