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Updated: Oct 19, 2025
Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Chronic intravascular coagulation in liver cirrhosis predicts a high hemorrhagic risk
M F Ruberto1, M S Piras, O Sorbello
1Hemostasis and Thrombosis Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy. rubertofilomena@tiscali.it.
Insights
Liver cirrhosis involves a hypercoagulable state with increased D-dimer and decreased fibrinogen/platelets, indicating increased hemorrhagic risk due to low-grade intravascular coagulation.
Area of Science:
- Hepatology
- Hematology
- Coagulation Disorders
Background:
- Liver cirrhosis presents a complex coagulopathy.
- The underlying mechanism may involve chronic consumption coagulopathy.
Purpose of the Study:
- To investigate if chronic consumption coagulopathy underlies the coagulopathy in liver cirrhosis.
- To assess the relationship between coagulation parameters and hemorrhagic risk.
Main Methods:
- Measured endogenous thrombin generation (ETP ratio) and D-dimer in 282 cirrhotic patients.
- Analyzed fibrinogen, platelet count, and hemorrhagic score.
- Compared ETP ratio and D-dimer in patients versus controls.
Main Results:
- Cirrhotic patients exhibited a hypercoagulable state (higher ETP ratio and D-dimer).
- Significant differences in fibrinogen, ETP ratio, D-dimer, and platelet count were observed based on hemorrhagic score and ETP ratio thresholds.
- Higher ETP ratio correlated with increased D-dimer and decreased fibrinogen/platelets.
Conclusions:
- Liver cirrhosis is associated with a hypercoagulable state.
- This state involves increased D-dimer and decreased fibrinogen/platelets, suggesting low-grade intravascular coagulation.
- This condition predicts a high hemorrhagic risk in cirrhotic patients.
Objective:
In liver cirrhosis, a complex coagulopathy does exist. The aim was to investigate whether a possible chronic consumption coagulopathy is the underlying phenomenon of the disease.
Patients And Methods:
We measured endogenous thrombin generation with and without thrombomodulin (ETP ratio) along with D-Dimer in a group of consecutive 282 cirrhotic patients. Fibrinogen, Platelet count and the Hemorrhagic score were previously computed in the same patients. The ETP ratio represents the resistance to the anticoagulant activity of TM and should be considered as an index of a procoagulant imbalance.
Results:
ETP ratio and D-Dimer showed higher values in the cirrhotic patients when compared to controls thus showing a hypercoagulable state. When the patients were divided based on the Hemorrhagic score >7, we found that Fibrinogen, ETP ratio, D-Dimer and the platelet count were significantly different between the two groups. Again, when we considered ETP ratio >0.88, the median value of the cirrhotic patients, all parameters, were statistically different between the two groups. D-Dimer were higher while fibrinogen and platelet count were statistically lower in cirrhotic patients with higher ETP ratio values. Even when the same patients were divided based on their platelet count ( 100 x 109/L) the results showed a similar behavior. ROC curves showed significant AUCs when the hemorrhagic score was challenged against Fibrinogen, D-Dimer, Platelet count and ETP ratio.
Conclusions:
In liver cirrhosis hypercoagulable state is associated with an increase in D-Dimer levels along with a decrease in fibrinogen and platelet count thus indicating a low-grade intravascular coagulation which predicts a high hemorrhagic risk.
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