Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests
Article first published online: 1 OCT 2012
© 2012 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 10, Issue 10, pages 2116–2122, October 2012
How to Cite
RIJKEN, D. C., KOCK, E. L., GUIMARÃES, A. H. C., TALENS, S., MURAD, S. D., JANSSEN, H. L. A. and LEEBEEK, F. W. G. (2012), Evidence for an enhanced fibrinolytic capacity in cirrhosis as measured with two different global fibrinolysis tests. Journal of Thrombosis and Haemostasis, 10: 2116–2122. doi: 10.1111/j.1538-7836.2012.04901.x
- Issue published online: 1 OCT 2012
- Article first published online: 1 OCT 2012
- Accepted manuscript online: 20 AUG 2012 10:33AM EST
- Received 8 December 2011, accepted 24 July 2012
- liver disease;
Summary. Background and objectives: It has been known for a long time that cirrhosis is associated with hyperfibrinolysis, which might contribute to an increased risk and severity of bleeding. However, recent papers have questioned the presence of a hyperfibrinolytic state in cirrhotic patients and postulated a rebalanced system owing to concomitant changes in both pro- and anti-fibrinolytic factors. Therefore we re-investigated the fibrinolytic state of cirrhotic patients using two different overall tests including a recently developed test for global fibrinolytic capacity (GFC) using whole blood.
Patients and methods: Blood was collected from 30 healthy controls and 75 patients with cirrhosis of varying severity (34 Child–Pugh A, 28 Child–Pugh B and 13 Child–Pugh C). The plasma clot lysis time (CLT), which is inversely correlated with fibrinolysis, was determined as well as the GFC.
Results: The mean CLT was 74.5 min in the controls and decreased significantly to 66.9 min in Child–Pugh class A patients, 59.3 min in class B patients and 61.0 min in class C patients, and hyperfibrinolysis existed in 40% of the patients. The median GFC was 1.7 μg mL−1 in the controls and increased significantly to 4.0 μg mL−1 in Child–Pugh class A patients, 11.1 μg mL−1 in class B patients and 22.5 μg mL−1 in class C patients, and hyperfibrinolysis existed in 43% of the patients. Taken together, 60% of the patients showed hyperfibrinolysis in at least one of the two global assays.
Conclusion: A rebalanced fibrinolytic system may occur, but hyperfibrinolysis is found in the majority of patients with cirrhosis.