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Association between high values of D-dimer and tissue-plasminogen activator activity and first gastrointestinal
1Istituto di I Clinica Medica, Universitã La Sapienza, Policlinico Umberto I, Roma, Italy.
Insights
Cirrhotic patients with hyperfibrinolysis, indicated by high D-dimer and tissue plasminogen activator (t-PA) activity, face a significantly higher risk of bleeding. Screening for hyperfibrinolysis can identify high-risk individuals.
Area of Science:
- Gastroenterology
- Hepatology
- Hematology
Background:
- Decompensated cirrhosis patients with high fibrin(ogen) degradation products are prone to bleeding.
- Hyperfibrinolysis is a known risk factor for bleeding in cirrhosis.
Purpose of the Study:
- To investigate the association between hyperfibrinolysis and bleeding events in cirrhotic patients.
- To measure plasma D-dimer and tissue plasminogen activator (t-PA) activity to assess hyperfibrinolysis.
Main Methods:
- 112 cirrhotic patients with esophageal varices and no prior bleeding were followed for 3 years.
- Hyperfibrinolysis was defined by concurrent high D-dimer and t-PA activity.
- Bleeding events and clinical factors were recorded.
Main Results:
- 30% of patients experienced bleeding during follow-up.
- Bleeding patients had more severe liver failure, larger varices, ascites, and red signs.
- Hyperfibrinolysis was the sole significant predictor of bleeding (Hazard Ratio = 42.5, p < 0.001).
Conclusions:
- Hyperfibrinolysis is a strong predictor of bleeding in cirrhotic patients.
- Screening for hyperfibrinolysis can help identify patients at increased risk of bleeding.
- This finding aids in proactive management of bleeding complications in cirrhosis.
Abstract:
Cirrhotic patients with decompensated state and high serum levels of fibrin(ogen) degradation products are at high risk of bleeding. The aim of this study was to further analyse the relationship between hyperfibrinolysis and bleeding in cirrhosis by measuring plasma values of D-dimer and tissue plasminogen activator (t-PA) activity. One-hundred-twelve cirrhotic patients with oesophageal varices and without previous upper-gastrointestinal bleeding entered the study and were followed-up for 3 years. Patients were considered to have hyperfibrinolysis if they concomitantly had high values of D-dimer and t-PA activity. During the follow-up 34 (30%) patients bled. They had more severe liver failure (p = 0.0001) and variceal size (p = 0.0031) and higher prevalence of ascites (p = 0.0003), varices with red signs and hyperfibrinolysis (p = 0.0001) than patients who did not bleed. Multivariate analysis disclosed hyperfibrinolysis as the only marker predictive of bleeding (Hazard Ratio = 42.5, p < 0.001). Our findings suggest that screening for hyperfibrinolysis may be useful to identify cirrhotic patients at risk of bleeding.