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Thrombin activation and increased fibrinolysis in patients with chronic liver disease
J A Páramo1, J Rifón, J Fernández
1Haematology Service, University Clinic, University of Navarra, Pamplona, Spain.
Insights
Severe liver disease patients show increased thrombin activity and hyperfibrinolysis, suggesting potential low-grade disseminated intravascular coagulation (DIC). These findings highlight the complex interplay between liver function and blood clotting mechanisms.
Area of Science:
- Hematology
- Hepatology
- Clinical Biochemistry
Background:
- Severe chronic liver disease significantly impacts hemostasis.
- Understanding the roles of coagulation and fibrinolysis is crucial in managing these patients.
Purpose of the Study:
- To assess the roles of intravascular coagulation and fibrinolysis in severe chronic liver disease.
- To investigate markers of thrombin activity and fibrinolysis in cirrhosis and chronic hepatitis.
Main Methods:
- Measured thrombin-antithrombin (TAT) complexes, tissue-type plasminogen activator antigen (tPA Ag), and fibrinogen/fibrin degradation products (FgDP/FbDP).
- Compared 66 patients (34 cirrhosis, 32 chronic hepatitis) with 30 healthy controls.
Main Results:
- Patients exhibited significantly elevated TAT complexes, tPA Ag, FgDP, and FbDP compared to controls.
- Higher FbDP levels were observed in cirrhosis patients versus chronic hepatitis patients.
- Correlations were found between hemostatic parameters and liver function tests.
Conclusions:
- Elevated TAT complexes indicate increased thrombin activity in severe liver disease.
- Hyperfibrinolysis, evidenced by increased FgDP/FbDP, suggests a potential low-grade disseminated intravascular coagulation (DIC).
- These findings underscore the hemostatic disturbances associated with chronic liver disease.
Abstract:
The respective roles of intravascular coagulation (DIC) and fibrinolysis were assessed in severe chronic liver disease by measuring thrombin-antithrombin (TAT) complexes, tissue-type plasminogen activator antigen (tPA Ag) and fibrinogen and fibrin degradation products (FgDP and FbDP respectively) in 66 patients with liver disease caused by cirrhosis (n = 34) or chronic hepatitis (n = 32) as compared to findings in a control group (n = 30). There was a significant increase of TAT complexes (P less than 0.01), tPA Ag (P less than 0.002), FDP and FbDP (P less than 0.001) in patients as compared to controls. FbDP increase was more evident in patients with cirrhosis than in those with hepatitis (P less than 0.01). Significant correlations between these parameters with some liver function tests were also demonstrated. Thus, in patients with severe liver disease, an increased thrombin activity, as demonstrated by high TAT levels; followed by hyperfibrinolysis suggest that a low grade DIC may occur.