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A DIC-like picture on plasma and ascitic fluid of cirrhotic patients
G M Patrassi1, M T Sartori, D Sgarabotto
1Institute of Medical Semeiotics, University of Padua Medical School, Italy.
Insights
Severe cirrhosis patients undergoing ascitic fluid reinfusion show signs of disseminated intravascular coagulation (DIC). Ascitic fluid itself is the primary cause of DIC following reinfusion, suggesting heparin treatment may be beneficial.
Area of Science:
- Hepatology
- Hematology
- Clinical Medicine
Background:
- Severe cirrhosis is often linked to disseminated intravascular coagulation (DIC).
- A subclinical DIC has been hypothesized in liver cirrhosis patients.
Purpose of the Study:
- To investigate coagulation and fibrinolysis in cirrhotic patients' plasma and ascitic fluid.
- To determine the role of ascitic fluid reinfusion in DIC pathogenesis.
Main Methods:
- Evaluated plasma and ascitic fluid parameters including PT, APTT, fibrinogen, plasminogen, antiplasmin, FDP, euglobulin lysis time, t-PA, and fibrinopeptide A.
- Assessed these parameters before and after ascitic fluid concentration-reinfusion therapy.
Main Results:
- Cirrhotic patients exhibited increased thrombin generation and hyperfibrinolysis in plasma.
- Ascitic fluid showed significantly elevated levels of thrombin and fibrinolysis activation.
- Ascitic fluid reinfusion procedures exacerbated DIC-like conditions.
Conclusions:
- A DIC-like state is present within the ascitic fluid of cirrhotic patients.
- Ascitic fluid is the main factor contributing to DIC following reinfusion procedures.
- Heparin therapy may be a successful treatment during ascitic fluid reinfusion.
Abstract:
Ascitic fluid reinfusion in severe cirrhosis has frequently been associated with intravascular coagulation (DIC). A low-grade DIC has been postulated to be present in liver cirrhosis. PT, APTT, fibrinogen, plasminogen, antiplasmin, fibrin degradation producers (FDP), euglobulin lysis time, tissue plasminogen activator, and fibrinopeptide A were investigated both in the plasma and ascitic fluid of cirrhotic patients before and after the concentration-reinfusion technique. Our results indicate that increased thrombin formation associated with hyperfibrinolysis is present in the plasma of cirrhotic patients. In ascitic fluid very high levels of thrombin and fibrinolysis activation were found. We conclude that (1) a DIC-like picture exists in ascites and (2) after ascites reinfusion procedures, ascitic fluid is the principal factor in the pathogenesis of DIC. During ascitic fluid reinfusion heparin treatment could be used successfully.