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Hyperfibrinolysis increases the risk of gastrointestinal hemorrhage in patients with advanced cirrhosis
Insights
Patients with liver failure and high fibrinogen degradation products face a greater risk of gastrointestinal bleeding. This study highlights hyperfibrinolysis as a key indicator of bleeding risk in advanced liver disease.
Area of Science:
- Hepatology
- Hematology
- Coagulation Science
Background:
- Liver failure significantly impacts coagulation and fibrinolysis.
- Child-Pugh class C liver failure patients exhibit more severe coagulopathy than class B.
- Hyperfibrinolysis, indicated by elevated fibrinogen degradation products (FDPs), is a concern in liver disease.
Purpose of the Study:
- To investigate the relationship between fibrinolysis markers and gastrointestinal bleeding risk in patients with liver failure.
- To compare coagulation and fibrinolysis profiles between Child-Pugh class B and C liver failure patients.
- To assess the prognostic value of FDPs and hyperfibrinolytic state in predicting mortality and bleeding events.
Main Methods:
- Prospective study of 61 patients with Child-Pugh class B (n=23) and C (n=38) liver failure over 3 years.
- Analysis of coagulation indices including prothrombin activity, activated partial thromboplastin time, bilirubin, fibrinogen, and FDPs.
- Measurement of circulating plasminogen activator antigen and activity, and plasminogen activator inhibitor antigen and activity in patients with elevated FDPs.
Main Results:
- Child-Pugh class C patients showed significantly worse coagulation profiles and higher FDPs than class B.
- 28 patients with FDPs > 10 µg/ml confirmed a hyperfibrinolytic state with increased plasminogen activator and decreased inhibitor.
- Patients with positive FDPs had higher bilirubin and lower fibrinogen levels.
- Elevated FDPs (OR=8) and Child-Pugh C (OR=3.5) were associated with a higher risk of gastrointestinal bleeding.
- 41 patients died during follow-up, 22 from gastrointestinal hemorrhage and 19 from liver failure.
Conclusions:
- Hyperfibrinolysis, evidenced by elevated FDPs, is prevalent in advanced liver failure and significantly increases the risk of gastrointestinal bleeding.
- Fibrinogen degradation products serve as a crucial biomarker for assessing bleeding risk and prognosis in liver failure patients.
- Child-Pugh classification and fibrinolytic markers are essential for risk stratification and management of patients with liver failure.
Abstract:
Sixty-one patients with different degrees of liver failure, 23 with Child-Pugh class B and 38 with Child-Pugh class C, were studied and observed for 3 yr. Coagulation index analysis showed significantly lower values of prothrombin activity, more prolonged activated partial thromboplastin time, higher bilirubin and fibrinogen degradation products values in class C patients. Among all patients, 28 had fibrinogen degradation products values greater than 10 micrograms/ml, and in these patients a hyperfibrinolytic state was confirmed by higher values of circulating plasminogen activator antigen (17.3 +/- 8.7 ng/ml vs. 5.41 +/- 1.9 ng/ml; p less than 0.0001) and activity (6.6 +/- 2.1 IU/ml vs. 1.92 +/- 1.12 IU/ml; p less than 0.0001) and significantly lower plasminogen activator inhibitor antigen (6.4 +/- 3.5 ng/ml vs. 15.8 +/- 5.6 ng/ml; p less than 0.0001) and activity (3.6 +/- 2.2 IU/ml vs. 8.5 +/- 3.9 IU/ml; p less than 0.0001). Patients with positive fibrinogen degradation products had higher serum bilirubin (6 +/- 4 mg/dl vs. 2 +/- 2 mg/dl; p less than 0.0001) and lower fibrinogen (156 +/- 52 mg/dl vs. 194 +/- 62 mg/dl; p less than 0.02) than patients without hyperfibrinolysis. During the follow-up period, 41 patients died, 22 from fatal gastrointestinal hemorrhage and 19 from liver failure. Thirty patients experienced fatal (22 patients) and nonfatal (8 patients) gastrointestinal hemorrhage. Patients with positive fibrinogen degradation products or class C had a higher risk of gastrointestinal bleeding than patients with negative fibrinogen degradation products (odds ratio = 8) or class B (odds ratio = 3.5), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)